Provider Demographics
NPI:1700058252
Name:SHIRODKAR, ALKA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALKA
Middle Name:
Last Name:SHIRODKAR
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 1:121 FAIR LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5411
Mailing Address - Country:US
Mailing Address - Phone:903-592-4160
Mailing Address - Fax:
Practice Address - Street 1:912 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2018
Practice Address - Country:US
Practice Address - Phone:903-592-6901
Practice Address - Fax:903-592-9986
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201399207Q00000X
TXN2804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine