Provider Demographics
NPI:1841398708
Name:SHUKLA, AMITABH (MD)
Entity Type:Individual
Prefix:
First Name:AMITABH
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MAIN ST
Mailing Address - Street 2:SUITE#201
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3247
Mailing Address - Country:US
Mailing Address - Phone:281-341-1500
Mailing Address - Fax:281-341-1505
Practice Address - Street 1:1601 MAIN ST
Practice Address - Street 2:SUITE#201
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3247
Practice Address - Country:US
Practice Address - Phone:281-341-1500
Practice Address - Fax:281-341-1505
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH59692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0027ETOtherBLUE CROSS BLUE SHIELD
E04582Medicare UPIN
TX0027ETOtherBLUE CROSS BLUE SHIELD