MEDICARE: DR. KELVIN S SHAW MD

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	207K00000X	Allergy & Immunology Physician	L6179	TX

General Provider Information

NPI Number	:	1548259922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELVIN S SHAW MD

Provider Business Mailing Address
First Line	:	1850 W LAKE HOUSTON PKWY
Second Line	:	SUITE 100
City	:	KINGWOOD
State	:	TX
Zip	:	77339-5237
Country	:	US
Telephone Number	:	281-540-7764
Fax Number	:	281-359-3340

Provider Business Practice Location Address
First Line	:	1850 W LAKE HOUSTON PKWY
Second Line	:	SUITE 100
City	:	KINGWOOD
State	:	TX
Zip	:	77339-5237
Country	:	US
Telephone Number	:	281-540-7764
Fax Number	:	281-359-3340

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	08/26/2015

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