Provider Demographics
NPI:1194729152
Name:SHAH, ATULKUMAR THAKORLAL (MD)
Entity type:Individual
Prefix:
First Name:ATULKUMAR
Middle Name:THAKORLAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ATUL
Other - Middle Name:T
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:950 E STATE HIGHWAY 114 STE 220
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5240
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:
Practice Address - Street 1:1001 N WALDROP DR STE 509
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4703
Practice Address - Country:US
Practice Address - Phone:817-394-4300
Practice Address - Fax:817-394-0200
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC167727207R00000X, 207RG0100X, 207RT0003X
TXJ1039207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100004129OtherRAILROAD MEDICARE
TX8AB810OtherBCBS
TX114957707Medicaid
TX8FX464OtherBLUE CROSS BLUE SHIELD
TXF03012Medicare UPIN
TX114957707Medicaid
TX8F6826Medicare PIN