MEDICARE: KOUSHIK K. 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	208800000X	Urology Physician	M0272	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
2	P00196306	OTHER	TX	RRMCR

General Provider Information

NPI Number	:	1811954423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOUSHIK K. SHAW MD

Provider Business Mailing Address
First Line	:	12319 N MOPAC EXPY
Second Line	:	SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78758-2414
Country	:	US
Telephone Number	:	512-694-8888
Fax Number	:	512-973-3036

Provider Business Practice Location Address
First Line	:	12319 N MOPAC EXPY
Second Line	:	SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78758-2414
Country	:	US
Telephone Number	:	512-694-8888
Fax Number	:	512-973-3036

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	06/12/2013

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