Provider Demographics
NPI:1356540330
Name:MADADI, SHILPA (MD)
Entity type:Individual
Prefix:
First Name:SHILPA
Middle Name:
Last Name:MADADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 HEMPHILL ST
Mailing Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4709
Mailing Address - Country:US
Mailing Address - Phone:817-927-3941
Mailing Address - Fax:817-927-3603
Practice Address - Street 1:1617 HEMPHILL ST
Practice Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4709
Practice Address - Country:US
Practice Address - Phone:817-927-3941
Practice Address - Fax:817-927-3603
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2179207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204810001Medicaid
TXFM1558545OtherDEA
TX8L16409Medicare PIN