Provider Demographics
NPI:1073598413
Name:KHAMBATI, SHAMIM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMIM
Middle Name:
Last Name:KHAMBATI
Suffix:
Gender:F
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:PO BOX 678513
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8513
Mailing Address - Country:US
Mailing Address - Phone:972-284-7000
Mailing Address - Fax:972-284-7001
Practice Address - Street 1:8210 WALNUT HILL LN
Practice Address - Street 2:SUITE 230
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4405
Practice Address - Country:US
Practice Address - Phone:972-284-7000
Practice Address - Fax:972-284-7001
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046398602Medicaid
TX8AG055OtherBCBS
TXH23202Medicare UPIN
TX8F6032Medicare PIN