Organization
IRA FIALKO DO PA
Active
Other names
Premier Pediatrics Coastal
Organization subpart
No
Provider details
NPI number
Authorized official
SHAHAB EUNUS MD (OWNER)
(352) 671-6741
Entity
Organization
Contact information
Practice address
6171 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429-2679
(352) 563-0220
(352) 563-0706
Mailing address
7960 SW 60TH AVE STE 100, OCALA, FL 34476-6409
(352) 671-6741
(352) 671-6742
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01118033
AMERIGROUP
FL
05
—
046778200
—
FL
01
—
121610464236
HUMANA
FL
01
—
202840
HEALTHEASE
FL
01
—
202840
STAYWELL
GA
01
—
267066600
FLORIDA MEDICAID GROUP #
FL
01
—
366272
MEDICARE
FL
01
—
82630
BCBS OF FLORIDA
FL
Enumeration date
09/14/2011
Last updated
09/02/2025
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