Provider Demographics
NPI:1285876151
Name:SHIMAN, MICHAEL IAN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:IAN
Last Name:SHIMAN
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 1:10075 S JOG RD STE 306
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3537
Mailing Address - Country:US
Mailing Address - Phone:561-424-7546
Mailing Address - Fax:561-244-6133
Practice Address - Street 1:10075 S JOG RD
Practice Address - Street 2:STE 306
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3535
Practice Address - Country:US
Practice Address - Phone:561-424-7546
Practice Address - Fax:561-244-6133
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114770207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHO539YOtherMEDICARE PTAN