Basic Information
| Provider Information | |||||||||
| NPI: | 1134120843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAPIRO | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 N HIATUS RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330265213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544387171 | ||||||||
| FaxNumber: | 9544381411 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 N HIATUS RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330265213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544387171 | ||||||||
| FaxNumber: | 9544381411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2005 | ||||||||
| LastUpdateDate: | 12/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/12/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | OS6777 | FL | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 376294700 | 05 | FL | MEDICAID |