Provider Demographics
NPI:1942248901
Name:DIGGIKAR, SHRINIVAS MADHUKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHRINIVAS
Middle Name:MADHUKAR
Last Name:DIGGIKAR
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 1:515 W MAYFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2083
Practice Address - Country:US
Practice Address - Phone:817-467-6092
Practice Address - Fax:817-465-0680
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7714207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175182801Medicaid
TX8S3357OtherBLUE CROSS OF TEXAS
TX175182802Medicaid
TXP00279557Medicare PIN
TX8S3357OtherBLUE CROSS OF TEXAS
TX175182801Medicaid
TX8D7713Medicare PIN