Provider Demographics
NPI:1194878975
Name:SHAN MEDICAL ASSOCIATION
Entity type:Organization
Organization Name:SHAN MEDICAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANEESH
Authorized Official - Middle Name:NATVARLAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-464-6042
Mailing Address - Street 1:11717 HIGHLAND MEADOW DR
Mailing Address - Street 2:#300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6830
Mailing Address - Country:US
Mailing Address - Phone:281-464-6042
Mailing Address - Fax:281-464-6706
Practice Address - Street 1:11717 HIGHLAND MEADOW DR
Practice Address - Street 2:#300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6830
Practice Address - Country:US
Practice Address - Phone:281-464-6042
Practice Address - Fax:281-464-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213085801Medicaid
TX0066CROtherBCBS
TXG68437Medicare UPIN
TX0A6027Medicare PIN