Provider Demographics
NPI:1295767861
Name:KADAKIA, SHAILESH C (MD)
Entity type:Individual
Prefix:
First Name:SHAILESH
Middle Name:C
Last Name:KADAKIA
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 1:520 E EUCLID AVE
Mailing Address - Street 2:SHAILESH C KADAKIA MD PA
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4414
Mailing Address - Country:US
Mailing Address - Phone:210-271-0606
Mailing Address - Fax:210-475-9806
Practice Address - Street 1:520 E EUCLID AVE
Practice Address - Street 2:SHAILESH C KADAKIA MD PA
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4414
Practice Address - Country:US
Practice Address - Phone:210-271-0606
Practice Address - Fax:210-475-9806
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0544174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143717001Medicaid
TX00257QMedicare PIN
00257QMedicare PIN
TXH38006Medicare UPIN
H38006Medicare UPIN