Provider Demographics
NPI:1700016789
Name:SHIRSALKAR, ADVAYANAND GIRISH (MD)
Entity Type:Individual
Prefix:DR
First Name:ADVAYANAND
Middle Name:GIRISH
Last Name:SHIRSALKAR
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 1:607 TIMBERDALE LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3049
Mailing Address - Country:US
Mailing Address - Phone:281-440-3005
Mailing Address - Fax:281-444-9070
Practice Address - Street 1:607 TIMBERDALE LN
Practice Address - Street 2:SUITE 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3049
Practice Address - Country:US
Practice Address - Phone:281-440-3005
Practice Address - Fax:281-444-9070
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0830207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EN668OtherBLUE CROSS BLUE SHIELD
TX8EN668OtherBLUE CROSS BLUE SHIELD