MEDICARE: TAD MICHAEL SHIRLEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	L2007	TX

General Provider Information

NPI Number	:	1295716777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAD MICHAEL SHIRLEY MD

Provider Business Mailing Address
First Line	:	8714 SPRING CYPRESS RD
Second Line	:	STE 200
City	:	SPRING
State	:	TX
Zip	:	77379-3395
Country	:	US
Telephone Number	:	281-374-8882
Fax Number	:	281-374-8886

Provider Business Practice Location Address
First Line	:	8714 SPRING CYPRESS RD STE 170
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3396
Country	:	US
Telephone Number	:	281-374-8882
Fax Number	:	281-374-8886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	06/11/2020

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