Healthcare Provider Details

I. General information

NPI: 1215371760
Provider Name (Legal Business Name): ANUSHA SHIRWAIKAR THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FANNIN ST
HOUSTON TX
77030-2703
US

IV. Provider business mailing address

1757 MANOR BROOK WAY
SNELLVILLE GA
30078-3061
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-5114
  • Fax: 713-790-6615
Mailing address:
  • Phone: 770-910-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number574226
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: