1871791590 NPI number — DR. SHAMIM JUSTIN BADIYAN M.D.

Table of content: DR. SHAMIM JUSTIN BADIYAN M.D. (NPI 1871791590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871791590 NPI number — DR. SHAMIM JUSTIN BADIYAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADIYAN
Provider First Name:
SHAMIM
Provider Middle Name:
JUSTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAKOURI
Provider Other First Name:
SHAMIM
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871791590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11500 HIGHWAY 121
Provider Second Line Business Mailing Address:
STE. 1010
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-219-8400
Provider Business Mailing Address Fax Number:
972-219-5331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11500 HIGHWAY 121
Provider Second Line Business Practice Location Address:
STE. 1010
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-219-8400
Provider Business Practice Location Address Fax Number:
972-219-5331
Provider Enumeration Date:
07/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  N8075 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8CY297 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 287577501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 287577503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 287577502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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