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Individual

PRAKASH BABU SHAH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
200 SE HOSPITAL AVE, STUART, FL 34994-2346
(772) 223-5618
(772) 288-5834
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 223-2832
(772) 223-5665

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME125031
FL
208M00000X
Hospitalist Physician
Primary
ME125031
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
016418500
FL
01
ZBIDH
FLORIDA BLUE
FL
Enumeration date
07/06/2011
Last updated
01/28/2021
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