MEDICARE: DR. SHYAM KISHAN 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	207X00000X	Orthopaedic Surgery Physician	01068071A	IN
2	207XP3100X	Pediatric Orthopaedic Surgery Physician	01068071A	IN
3	207X00000X	Orthopaedic Surgery Physician	R1799	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000674113	OTHER	IN	ANTHEM PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689644528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHYAM KISHAN MD

Provider Business Mailing Address
First Line	:	4128 FAIR MEADOWS DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-3457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5680 FRISCO SQUARE BLVD STE 2500
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-3315
Country	:	US
Telephone Number	:	972-347-4783
Fax Number	:	972-347-4916

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	01/04/2022

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Directions to “ DR. SHYAM KISHAN MD” Practice Location

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