Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | ME92264 | FL |
NPI | 1376532580 |
---|---|
Provider Name | Shahid Rasul Randhawa |
First Address | Oakland Park, FL 33334-3453 |
Second Address | Fort Lauderdale, FL 33306-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 05/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003737500 | (05) | FL |
139893 | (02) | FL |
16010 | BCBS (01) | FL |