Provider Demographics
NPI:1013200062
Name:KIDWAI, SHAHROZ (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHROZ
Middle Name:
Last Name:KIDWAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3201 CORSICANA CROSSING BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75109
Mailing Address - Country:US
Mailing Address - Phone:903-872-6065
Mailing Address - Fax:903-641-0516
Practice Address - Street 1:1321 W 2ND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3798
Practice Address - Country:US
Practice Address - Phone:903-874-9206
Practice Address - Fax:903-874-4234
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ1433207Q00000X, 208M00000X, 207P00000X
NMMD2013-0797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist