Provider Demographics
NPI:1699881649
Name:MANJUNATH, SHIKARIPUR D (MD,)
Entity type:Individual
Prefix:
First Name:SHIKARIPUR
Middle Name:D
Last Name:MANJUNATH
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 1:5960 W PARKER RD STE 278
Mailing Address - Street 2:PMB 121
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7792
Mailing Address - Country:US
Mailing Address - Phone:469-774-8442
Mailing Address - Fax:972-747-1663
Practice Address - Street 1:5960 W PARKER RD STE 278
Practice Address - Street 2:PMB 121
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7792
Practice Address - Country:US
Practice Address - Phone:469-774-8442
Practice Address - Fax:972-747-1663
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4140208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX250014099OtherRAILROAD MEDICARE
TX0016JAOtherBCBS
TX250014099OtherRAILROAD MEDICARE
TX00646FMedicare PIN
TX00647FMedicare PIN