=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871791590
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAMIM JUSTIN BADIYAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2007
-----------------------------------------------------
Last Update Date | 07/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11500 HIGHWAY 121 STE. 1010
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-219-8400
-----------------------------------------------------
Fax | 972-219-5331
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11500 HIGHWAY 121 STE. 1010
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-219-8400
-----------------------------------------------------
Fax | 972-219-5331
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | N8075
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------