Provider Demographics
NPI:1386735587
Name:KUMAR, SHITAL DESAI (DO)
Entity type:Individual
Prefix:DR
First Name:SHITAL
Middle Name:DESAI
Last Name:KUMAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:706 W BEN WHITE BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8144
Mailing Address - Country:US
Mailing Address - Phone:512-978-9300
Mailing Address - Fax:512-279-2556
Practice Address - Street 1:1210 W BRAKER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-3801
Practice Address - Country:US
Practice Address - Phone:512-978-9300
Practice Address - Fax:512-279-2556
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM0138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J0654Medicare PIN
TXI65922Medicare UPIN