Provider Demographics
NPI:1215982723
Name:TUKDI, SHAKIL A (MD)
Entity type:Individual
Prefix:
First Name:SHAKIL
Middle Name:A
Last Name:TUKDI
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:PO BOX 250447
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0447
Mailing Address - Country:US
Mailing Address - Phone:972-596-4393
Mailing Address - Fax:972-596-4840
Practice Address - Street 1:5501 INDEPENDENCE PKWY
Practice Address - Street 2:STE 302
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5470
Practice Address - Country:US
Practice Address - Phone:469-661-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL89862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165550805Medicaid
TX165550803Medicaid
TX165550805Medicaid
TX165550803Medicaid
TX8K5241Medicare PIN