Individual
DR. PREM C SHUKLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
265 BROOKVIEW CENTRE WAY STE 400, KNOXVILLE, TN 37919-4052
(800) 342-2898
Mailing address
3506 SPEEDWAY APT 204, AUSTIN, TX 78705-1551
(800) 342-2898
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
K6929
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0065PT
BCBS
TX
05
—
043985335
—
TX
01
—
P01157825
RAILROAD MEDICARE
TX
Enumeration date
06/14/2006
Last updated
08/15/2016
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