Provider Demographics
NPI:1508938556
Name:PATEL, SHIVANI HITESH (MD)
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:HITESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIVANI
Other - Middle Name:YOGENDRA
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2501 E HEBRON PKWY
Mailing Address - Street 2:STE 500
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4403
Mailing Address - Country:US
Mailing Address - Phone:972-300-4171
Mailing Address - Fax:
Practice Address - Street 1:2501 E HEBRON PKWY
Practice Address - Street 2:STE 500
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4403
Practice Address - Country:US
Practice Address - Phone:972-300-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0523207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AQ370OtherBCBS
TXAAOther261717123
TX8F6842Medicare PIN
TX8AQ370OtherBCBS