SHAHLA MEDICAL GROUP, PA
Osteopathic Medicine at Terrene Ct, Bonita Springs, FL

License number
Florida ME0066854
Category
Osteopathic Medicine
Type
Internal Medicine
Owner
Name: ZIAD SHAHLA MD
Title: PRESIDENT
Phone: (239) 948-3444
Address
Address
8800 Terrene Ct STE 102, Bonita Springs, FL 34135
National Provider ID: 1902833288
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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SHAHLA MEDICAL GROUP, PA

Bonita Springs, FL

Status:
Inactive
Inactive reason:
NAME CHANGE AMENDMENT
Registration:
Mar 23, 1999
Inactive since:
Feb 17, 2011
Addresses:
8800 Terrene Ct 102, Bonita Springs, FL 34135 (Physical)
8800 Terrene Ct, Bonita Springs, FL 34135
State ID:
P99000026538
Business type:
Florida Profit Corporation
Director, Vice Presidents:
Ziad Shahla (President, Director, Vice President), 8800 Terrene Ct, Bonita Springs, FL 34135 (Physical),Heidi L. Fleer Director, Vice President, inactive
Agent:
Shahla, Ziad,8800 Terrene Ct, Bonita Springs, FL 34135 (Physical)
EIN:
59-3562824

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