Provider Demographics
NPI:1609872928
Name:SHANTI, IHSAN FAHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:IHSAN
Middle Name:FAHMI
Last Name:SHANTI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5300 N BRAESWOOD BLVD # 376
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-3307
Mailing Address - Country:US
Mailing Address - Phone:713-339-1566
Mailing Address - Fax:713-339-1518
Practice Address - Street 1:5611 BELLAIRE BLVD # 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5617
Practice Address - Country:US
Practice Address - Phone:713-339-1566
Practice Address - Fax:713-465-5965
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK4562207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG83865Medicare UPIN