Provider Demographics
NPI:1942362520
Name:NAIK, SHANTANU SHREEPAD (MD)
Entity Type:Individual
Prefix:
First Name:SHANTANU
Middle Name:SHREEPAD
Last Name:NAIK
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 1:6300 LA CALMA DR.
Mailing Address - Street 2:STE. 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3825
Mailing Address - Country:US
Mailing Address - Phone:888-800-8237
Mailing Address - Fax:512-610-0392
Practice Address - Street 1:1401 MEDICAL PKWY STE 412
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5015
Practice Address - Country:US
Practice Address - Phone:512-379-3636
Practice Address - Fax:512-379-3641
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078639207R00000X
TXM5396207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X6780OtherBCBSTX PIN