Provider Demographics
NPI:1629074208
Name:SHETH, MUKESH R (MD)
Entity Type:Individual
Prefix:
First Name:MUKESH
Middle Name:R
Last Name:SHETH
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 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:ATT. BILLING
Mailing Address - City:DENSION
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-465-3624
Mailing Address - Fax:903-465-3973
Practice Address - Street 1:5026 POOL ROAD
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4595
Practice Address - Country:US
Practice Address - Phone:903-465-3624
Practice Address - Fax:903-465-3973
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5061207RI0011X, 207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100033830AMedicaid
OK16625OtherMEDICAL LICENSURE
TX131311608Medicaid
TX385459YSYFMedicare PIN
TXC21752Medicare UPIN
OK100033830AMedicaid