MUBARIK AHMAD SHAH MD PA
Radiology at Via Poinciana, Lake Worth, FL

License number
Florida ME89362
Category
Radiology
Type
Surgery
License number
Florida ME89362
Category
Radiology
Type
Vascular Surgery
Owner
Name: MUBARIK A SHAH M.D.
Title: PRESIDENT
Phone: (561) 721-3939
Address
Address
3918 Via Poinciana SUITE 10, Lake Worth, FL 33467
National Provider ID: 1467640151
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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MUBARIK AHMAD SHAH, M.D., PA

Lake Worth, FL  -  West Palm Beach, FL

Status:
Inactive
Inactive reason:
VOLUNTARY DISS W/ NOTICE
Registration:
May 3, 2004
Inactive since:
Jun 3, 2009
Addresses:
3918 Via Poinciana Suitr 10, Lake Worth, FL 33467 (Physical)
2700 Danforth Ter, West Palm Beach, FL 33414
State ID:
P04000071857
Business type:
Florida Profit Corporation
Director:
Mubarik Ahmad Md Shah Director, inactive, 3918 Via Poinciana SUITE 10, Lake Worth, FL 33467 (Physical)
Agent:
Timothy Monaghan,Strawn Monaghan & Cohen Pa, Delray Beach, FL 33483 (Physical)
EIN:
20-1087718

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