Provider Demographics
NPI:1720100811
Name:TUJIOS, SHANNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNAN
Middle Name:
Last Name:TUJIOS
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 1:3355 BLACKBURN ST APT 8209
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1550
Mailing Address - Country:US
Mailing Address - Phone:734-945-5490
Mailing Address - Fax:
Practice Address - Street 1:5959 HARRY HINES BLVD
Practice Address - Street 2:ROOM HP5.520G
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-8887
Practice Address - Country:US
Practice Address - Phone:214-645-8183
Practice Address - Fax:214-645-6294
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7014207RG0100X
MI4301083901390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program