Provider Demographics
NPI:1326047259
Name:DHADUK, SHAILESH D (MD)
Entity Type:Individual
Prefix:
First Name:SHAILESH
Middle Name:D
Last Name:DHADUK
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 1:2709 OSLER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2518
Mailing Address - Country:US
Mailing Address - Phone:979-776-2200
Mailing Address - Fax:
Practice Address - Street 1:2709 OSLER BLVD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2518
Practice Address - Country:US
Practice Address - Phone:979-776-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U4230OtherBCBS OF TEXAS
TX8U4230OtherBCBS OF TEXAS
H70088Medicare UPIN