MEDICARE: SHAAD B BIDIWALA M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	L8619	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255350104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAAD B BIDIWALA M.D

Provider Business Mailing Address
First Line	:	6080 N CENTRAL EXPY STE 150
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5202
Country	:	US
Telephone Number	:	214-823-2052
Fax Number	:	214-823-3797

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE
Second Line	:	SUITE 907
City	:	DALLAS
State	:	TX
Zip	:	75246-1800
Country	:	US
Telephone Number	:	214-823-2052
Fax Number	:	214-823-5747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/18/2020

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Directions to “ SHAAD B BIDIWALA M.D” Practice Location

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