Provider Demographics
NPI:1770504136
Name:SHIVNANI, ANAND THANWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANAND
Middle Name:THANWAR
Last Name:SHIVNANI
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:BUILDING D, SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-566-7031
Practice Address - Fax:972-566-7942
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010776972085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182606706Medicaid
OK200104380AMedicaid
TX182606701Medicaid
TX182606705Medicaid
TX182606708Medicaid
TX182606709Medicaid
TX182606704Medicaid
TX182606703Medicaid
TX182606707Medicaid
TXP00412720Medicare PIN
TX8G6817Medicare PIN
TX182606708Medicaid
TX8J1089Medicare PIN
OK200104380AMedicaid
TXTXB118526Medicare PIN
TX182606701Medicaid
TX182606707Medicaid