Provider Demographics
NPI:1093748618
Name:SHENOY, RAGHUVEER BALKUNJE (MD)
Entity Type:Individual
Prefix:
First Name:RAGHUVEER
Middle Name:BALKUNJE
Last Name:SHENOY
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 1:2222 ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-2206
Mailing Address - Country:US
Mailing Address - Phone:512-465-4840
Mailing Address - Fax:512-465-4841
Practice Address - Street 1:2222 ROSEWOOD AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-2206
Practice Address - Country:US
Practice Address - Phone:512-465-4840
Practice Address - Fax:512-465-4841
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU1379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150449Medicaid
OR110145756OtherRR MEDICARE
ORR100318Medicare PIN
OR110145756OtherRR MEDICARE
ORR164075Medicare PIN
ORR162755Medicare PIN
ORR164076Medicare PIN
OR150449Medicaid