Provider Demographics
NPI:1558322552
Name:SHAHAB, IMRAN (MD)
Entity Type:Individual
Prefix:
First Name:IMRAN
Middle Name:
Last Name:SHAHAB
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 1:6124 W. PARKER ROAD
Mailing Address - Street 2:SUITE G-36
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8124
Mailing Address - Country:US
Mailing Address - Phone:972-981-3107
Mailing Address - Fax:972-981-3236
Practice Address - Street 1:6124 W. PARKER ROAD
Practice Address - Street 2:SUITE G-36
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8124
Practice Address - Country:US
Practice Address - Phone:972-981-3107
Practice Address - Fax:972-981-3236
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0866207RH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103350803Medicaid
TX220031535Medicare PIN
G21864Medicare UPIN
TX8886N1Medicare PIN