Provider Demographics
NPI:1497763304
Name:PURSWANI, SHYAM (MD)
Entity Type:Individual
Prefix:
First Name:SHYAM
Middle Name:
Last Name:PURSWANI
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 1:2425 BABCOCK RD
Mailing Address - Street 2:STE 108
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-616-9400
Mailing Address - Fax:210-616-9402
Practice Address - Street 1:2455 NE LOOP 410 STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5650
Practice Address - Country:US
Practice Address - Phone:210-590-9080
Practice Address - Fax:210-590-9087
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1005208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0297020-02Medicaid
TXB153365OtherWELLMED NETWORKS INC
TXB153365OtherWELLMED NETWORKS INC
G39302Medicare UPIN
TX5234070001Medicare NSC