=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972782977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHATISHKUMAR Y PATEL, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2007
-----------------------------------------------------
Last Update Date | 04/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8200 WEDNESBURY LN SUITE 295
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-2925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-533-0995
-----------------------------------------------------
Fax | 713-772-5475
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8200 WEDNESBURY LN STE 290
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-533-0995
-----------------------------------------------------
Fax | 713-772-5475
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHATISHKUMAR Y PATEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 713-533-0995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | L0495
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------