Provider Demographics
NPI:1922127075
Name:PATNI, SHAMIM (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SHAMIM
Middle Name:
Last Name:PATNI
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:SHAMIM
Other - Middle Name:B
Other - Last Name:PATNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:208 OAK DR S
Mailing Address - Street 2:SUITE 700
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5790
Mailing Address - Country:US
Mailing Address - Phone:979-230-4852
Mailing Address - Fax:979-230-4863
Practice Address - Street 1:208 OAK DR S
Practice Address - Street 2:SUITE 700
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5790
Practice Address - Country:US
Practice Address - Phone:979-230-4852
Practice Address - Fax:979-230-4863
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6649207QA0505X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF85043Medicare UPIN