MEDICARE: DR. RAJ HARRY SHANI 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	P2786	TX
2	207X00000X	Orthopaedic Surgery Physician	BP1-0029080	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4641596073	OTHER		MYUTMB 4641596073

General Provider Information

NPI Number	:	1588855779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJ HARRY SHANI MD

Provider Business Mailing Address
First Line	:	10125 KATY FWY STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1287
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10125 KATY FWY STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1287
Country	:	US
Telephone Number	:	713-486-1700
Fax Number	:

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

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	07/28/2022

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