MEDICARE: DR. SHEHANAZ KADER ELLIKA 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	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	4301091174	MI
2	2085N0700X	Neuroradiology Physician	292136	NY
3	2085N0700X	Neuroradiology Physician	4301091174	MI
4	2085R0202X	Diagnostic Radiology Physician	V5070	TX
5	2085P0229X	Pediatric Radiology Physician	V5070	TX

General Provider Information

NPI Number	:	1902064819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEHANAZ KADER ELLIKA MD

Provider Business Mailing Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7201
Country	:	US
Telephone Number	:	214-456-4036
Fax Number	:	214-645-0078

Provider Business Practice Location Address
First Line	:	1935 MEDICAL DISTRICT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7701
Country	:	US
Telephone Number	:	214-456-4036
Fax Number	:	214-645-0078

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

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	02/05/2025

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