Provider Demographics
NPI:1366450579
Name:PATEL, SHATISHKUMAR Y (MD)
Entity Type:Individual
Prefix:
First Name:SHATISHKUMAR
Middle Name:Y
Last Name:PATEL
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 1:8200 WEDNESBURY LN
Mailing Address - Street 2:SUITE 295
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2925
Mailing Address - Country:US
Mailing Address - Phone:713-533-0995
Mailing Address - Fax:713-772-5475
Practice Address - Street 1:8200 WEDNESBURY LN
Practice Address - Street 2:SUITE 295
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2925
Practice Address - Country:US
Practice Address - Phone:713-533-0995
Practice Address - Fax:713-772-5475
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0495207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0039KJOtherBC/BS
TX148933802Medicaid
TXDA5819OtherRAILROAD MEDICARE
TX148933802Medicaid
TX8A5726Medicare PIN