Provider Demographics
NPI:1407002215
Name:SHAILESH C. KADAKIA, M.D., P.A.
Entity Type:Organization
Organization Name:SHAILESH C. KADAKIA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAILESH
Authorized Official - Middle Name:C
Authorized Official - Last Name:KADAKIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-481-7477
Mailing Address - Street 1:225 E SONTERRA BLVD
Mailing Address - Street 2:STE 215
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3992
Mailing Address - Country:US
Mailing Address - Phone:210-481-7477
Mailing Address - Fax:210-481-7622
Practice Address - Street 1:225 E SONTERRA BLVD
Practice Address - Street 2:STE 215
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3992
Practice Address - Country:US
Practice Address - Phone:210-481-7477
Practice Address - Fax:210-481-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0544207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00257QMedicare PIN
TXH38006Medicare UPIN