Provider Demographics
NPI:1255374302
Name:SHAH, KIRAN (MD)
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:SHAH
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 1:4217 MARSH RIDGE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010
Mailing Address - Country:US
Mailing Address - Phone:972-306-6300
Mailing Address - Fax:972-306-6500
Practice Address - Street 1:4217 MARSH RIDGE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:972-306-6300
Practice Address - Fax:972-306-6500
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK10582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AP801OtherBCBS
TX0021CFOtherBC/BS
TX8F6108Medicare PIN
TXG27132Medicare UPIN
TX8AP801OtherBCBS