Provider Demographics
NPI:1194981498
Name:SHAIK, IMTIAZUDDIN (MD)
Entity type:Individual
Prefix:DR
First Name:IMTIAZUDDIN
Middle Name:
Last Name:SHAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 TURKEY LAKE RD STE 114
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8015
Mailing Address - Country:US
Mailing Address - Phone:407-354-1202
Mailing Address - Fax:407-351-8801
Practice Address - Street 1:9430 TURKEY LAKE RD STE 114
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8015
Practice Address - Country:US
Practice Address - Phone:407-354-1202
Practice Address - Fax:407-351-8801
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121450204F00000X
FLME126757204F00000X, 208600000X
NY275722204F00000X
OH57014187390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018738400Medicaid
CA1194981498Medicaid