Provider Demographics
NPI:1629054358
Name:SHAH, DHIREN L (MD)
Entity Type:Individual
Prefix:
First Name:DHIREN
Middle Name:L
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DHIRENDRA
Other - Middle Name:L
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:530 CLARA BARTON BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5752
Mailing Address - Country:US
Mailing Address - Phone:972-497-1117
Mailing Address - Fax:972-494-2082
Practice Address - Street 1:530 CLARA BARTON BLVD STE 150
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5752
Practice Address - Country:US
Practice Address - Phone:972-487-1117
Practice Address - Fax:972-494-2082
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4206207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX894032OtherBCBS
TX133771908Medicaid
TX133771908Medicaid
C21641Medicare UPIN
TX60064123Medicare PIN