Provider Demographics
NPI:1376710095
Name:DAS, SHOUNAK (MD)
Entity Type:Individual
Prefix:
First Name:SHOUNAK
Middle Name:
Last Name:DAS
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 1:8210 WALNUT HILL LN STE 718
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4412
Mailing Address - Country:US
Mailing Address - Phone:214-345-7377
Mailing Address - Fax:214-345-5052
Practice Address - Street 1:8210 WALNUT HILL LN STE 718
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4412
Practice Address - Country:US
Practice Address - Phone:214-345-7377
Practice Address - Fax:214-345-5052
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196850501Medicaid
TX196850502Medicaid
TX8AD598OtherBCBS
TX8F20893Medicare PIN
TX8K7470Medicare PIN