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General NPI Number Information
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NPI Number | 1043449465
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Entity Type | Individual
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Provider Name | NATRAJ AIYAPPAN SHANMUGAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 1602 ROCK PRAIRIE RD SUITE 210
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City | COLLEGE STATION
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State | TX
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Zip | 77845-8306
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Country | US
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Telephone | 979-696-5663
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Fax | 979-694-1319
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Provider Business Mailing Address
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Address Line | 1602 ROCK PRAIRIE RD SUITE 210
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City | COLLEGE STATION
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State | TX
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Zip | 77845-8306
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Country | US
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Telephone | 979-696-5663
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Fax | 979-694-1319
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P8538
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License Number State | TX
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