Healthcare Provider Details

I. General information

NPI: 1619806429
Provider Name (Legal Business Name): SHIRSAT MD PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 CORINTH CIR
BOSSIER CITY LA
71111-6441
US

IV. Provider business mailing address

603 CORINTH CIR
BOSSIER CITY LA
71111-6441
US

V. Phone/Fax

Practice location:
  • Phone: 816-872-6459
  • Fax:
Mailing address:
  • Phone: 816-872-6459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: PALLAVI SHIRSAT
Title or Position: NEPHROLOGIST
Credential: MD
Phone: 816-872-6459