Healthcare Provider Details

I. General information

NPI: 1720467319
Provider Name (Legal Business Name): MADIHA SHAHID YAZDANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 22ND ST
LUBBOCK TX
79410-1334
US

IV. Provider business mailing address

9127 JUSTICE AVE
LUBBOCK TX
79424-7861
US

V. Phone/Fax

Practice location:
  • Phone: 806-796-3000
  • Fax: 806-796-3006
Mailing address:
  • Phone: 615-300-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberS7828
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0007961
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberS7828
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: