Provider Demographics
NPI:1144241928
Name:ORSAK, SHANNON MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MICHAEL
Last Name:ORSAK
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 1:7507 GUINEVERE DR
Mailing Address - Street 2:
Mailing Address - City:SUGARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:281-343-9975
Mailing Address - Fax:815-642-1135
Practice Address - Street 1:16062 SOUTHWEST FREEEWAY #2
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-980-4357
Practice Address - Fax:281-980-4445
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2976207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B7192Medicare ID - Type UnspecifiedPROVIDER #
TXG69380Medicare UPIN