Healthcare Provider Details

I. General information

NPI: 1053372482
Provider Name (Legal Business Name): LEENA N SHROFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 W OHIO
MIDLAND TX
79701
US

IV. Provider business mailing address

PO BOX 744127
DALLAS TX
75374
US

V. Phone/Fax

Practice location:
  • Phone: 432-683-3206
  • Fax: 432-683-2616
Mailing address:
  • Phone: 432-683-3206
  • Fax: 432-683-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberE9991
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: