MEDICARE: DR. IHSAN FAHMI SHANTI M.D.

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	207L00000X	Anesthesiology Physician	K4562	TX

General Provider Information

NPI Number	:	1609872928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IHSAN FAHMI SHANTI M.D.

Provider Business Mailing Address
First Line	:	5300 N BRAESWOOD BLVD # 376
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-3307
Country	:	US
Telephone Number	:	713-339-1566
Fax Number	:	713-339-1518

Provider Business Practice Location Address
First Line	:	5611 BELLAIRE BLVD # 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-5617
Country	:	US
Telephone Number	:	713-339-1566
Fax Number	:	713-465-5965

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/09/2007

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