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General NPI Number Information
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NPI Number | 1770364838
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Entity Type | Individual
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Provider Name | SHUTA ISHIGAMI
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Gender | Male
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Dates
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Enumeration Date | 10/13/2023
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Last Update Date | 03/01/2026
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Provider Practice Location Address
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Address Line | 6651 MAIN ST
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City | HOUSTON
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State | TX
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Zip | 77030-2351
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Country | US
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Telephone | 832-822-1359
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Fax |
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Provider Business Mailing Address
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Address Line | 1850 OLD MAIN ST APT 2506
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City | HOUSTON
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State | TX
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Zip | 77030-2224
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Country | US
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Telephone | 713-257-3346
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Fax |
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 48140
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License Number State | TX
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