Provider Demographics
NPI:1609823541
Name:PERVEEN, SHAMSA (MD)
Entity Type:Individual
Prefix:
First Name:SHAMSA
Middle Name:
Last Name:PERVEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 HIGHWAY 6 S
Mailing Address - Street 2:EXCEL CLINIC PA
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-3305
Mailing Address - Country:US
Mailing Address - Phone:281-776-9235
Mailing Address - Fax:281-776-0404
Practice Address - Street 1:7035 HIGHWAY 6 S
Practice Address - Street 2:EXCEL CLINIC PA
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-3305
Practice Address - Country:US
Practice Address - Phone:281-776-9235
Practice Address - Fax:281-776-0404
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182959001Medicaid
TXI63272Medicare UPIN
TX612633Medicare PIN