Provider Demographics
NPI:1154542181
Name:SHANKS, TODD STILES (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:STILES
Last Name:SHANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 STATE HIGHWAY 121 STE 1010
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-9347
Mailing Address - Country:US
Mailing Address - Phone:214-807-0445
Mailing Address - Fax:214-817-1006
Practice Address - Street 1:11500 STATE HIGHWAY 121 STE 1010
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-9347
Practice Address - Country:US
Practice Address - Phone:214-807-0445
Practice Address - Fax:214-817-1006
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40612207T00000X
IN01068505A207T00000X
TXS9413207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200952360Medicaid
KY7100075340Medicaid
INM400052993Medicare PIN
3704059000OtherPASSPORT ADVANTAGE/NNIKY
KY7100075340Medicaid
KY00553126Medicare PIN
103558OtherSIHO/NNIKY
KY000000609723OtherNNIKY/ANTHEM
0000519831OtherNIKY/HUMANA
INM400052993Medicare PIN