Individual
CANDICE E. SHUTKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6431 FANNIN ST # 5.197, HOUSTON, TX 77030-1501
(713) 500-6200
Mailing address
6431 FANNIN ST # 5.197, HOUSTON, TX 77030-1501
(713) 500-6200
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
M4541
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1880197 01
—
TX
01
—
8U4527
BLUE CROSS PROVIDER ID
TX
Enumeration date
01/30/2007
Last updated
01/28/2009
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