Provider Demographics
NPI:1063611739
Name:BHULLAR, SHAMINDER SINGH (MD)
Entity type:Individual
Prefix:
First Name:SHAMINDER
Middle Name:SINGH
Last Name:BHULLAR
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 1:11373 CORTEZ BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5414
Mailing Address - Country:US
Mailing Address - Phone:352-597-2604
Mailing Address - Fax:352-596-0520
Practice Address - Street 1:11373 CORTEZ BLVD
Practice Address - Street 2:STE 400
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5414
Practice Address - Country:US
Practice Address - Phone:352-597-2604
Practice Address - Fax:352-596-0520
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0008207W00000X
FLME112489207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005945600Medicaid
FLGC114ZMedicare PIN