MEDICARE: MINI DELASHAW 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	207P00000X	Emergency Medicine Physician	M3515	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8V2879	OTHER	TX	BCBS
2	P00364139	OTHER	TX	RAILROAD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952344202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINI DELASHAW MD

Provider Business Mailing Address
First Line	:	12221 MERIT DR
Second Line	:	SUITE 1610
City	:	DALLAS
State	:	TX
Zip	:	75251-2202
Country	:	US
Telephone Number	:	832-498-6356
Fax Number	:

Provider Business Practice Location Address
First Line	:	12221 MERIT DR
Second Line	:	SUITE 1610
City	:	DALLAS
State	:	TX
Zip	:	75251-2202
Country	:	US
Telephone Number	:	832-498-6356
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	06/29/2011

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Directions to “ MINI DELASHAW MD” Practice Location

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