Individual
DR. AIYANADAR SHANMUGAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D F.A.C.E, F.A.C.E
Contact information
Practice address
1602 ROCK PRAIRIE RD, SUITE 210, COLLEGE STATION, TX 77845-8306
(979) 696-5663
(979) 693-1274
Mailing address
1602 ROCK PRAIRIE RD, SUITE 210, COLLEGE STATION, TX 77845-8306
(979) 696-5663
(979) 693-1274
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
74-2273494
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00AQ85
BLUE CROSS BLUE SHIELD
TX
05
—
110539701
—
TX
Enumeration date
07/31/2006
Last updated
07/08/2007
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