Provider Demographics
NPI:1073947818
Name:NAGALLI, SHIVARAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVARAJ
Middle Name:
Last Name:NAGALLI
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 1:7624 WARREN PKWY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4158
Mailing Address - Country:US
Mailing Address - Phone:469-893-6037
Mailing Address - Fax:469-893-7037
Practice Address - Street 1:1000 1ST ST N
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8703
Practice Address - Country:US
Practice Address - Phone:205-620-7004
Practice Address - Fax:205-620-8688
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50125208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist