Provider Demographics
NPI:1720042070
Name:SHAHIN, ISLAM A (MD)
Entity Type:Individual
Prefix:
First Name:ISLAM
Middle Name:A
Last Name:SHAHIN
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 1:1750 N HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2306
Mailing Address - Country:US
Mailing Address - Phone:214-420-5460
Mailing Address - Fax:214-946-4399
Practice Address - Street 1:1750 N HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2306
Practice Address - Country:US
Practice Address - Phone:214-420-5460
Practice Address - Fax:214-946-4399
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN53902085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I35451Medicare UPIN