Provider Demographics
NPI:1336113851
Name:SHASHIKUMAR, SHIVARAMAIAH (MD)
Entity Type:Individual
Prefix:
First Name:SHIVARAMAIAH
Middle Name:
Last Name:SHASHIKUMAR
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 1:1111 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3476
Mailing Address - Country:US
Mailing Address - Phone:281-296-8788
Mailing Address - Fax:281-419-1291
Practice Address - Street 1:1111 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 250
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3476
Practice Address - Country:US
Practice Address - Phone:281-296-8788
Practice Address - Fax:281-419-1291
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003015692207R00000X, 208M00000X
IL036135951207RC0200X, 207R00000X
TXP7565207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209115500Medicaid
TX327502603Medicaid
TX8EF484OtherBLUE CROSS BLUE SHIELD
TX8EF484OtherBLUE CROSS BLUE SHIELD
MO909131390Medicare PIN
MOH98406Medicare UPIN
MO209115500Medicaid
TX327502603Medicaid
TX322112YK6UMedicare PIN