Individual
DR. KESAVAN SHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, FACC
Contact information
Practice address
16651 SOUTHWEST FREEWAY MOB1, SUITE 450, SUGAR LAND, TX 77479
(281) 275-0330
(281) 275-0331
Mailing address
16651 SOUTHWEST FREEWAY MOB1, SUITE 450, SUGAR LAND, TX 77479
(281) 275-0330
(281) 275-0331
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
K1925
TX
207RI0011X
Interventional Cardiology Physician
K1925
TX
207UN0901X
Nuclear Cardiology Physician
K1925
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060062836
RAILROAD MEDICARE
TX
05
—
116637302
—
TX
05
—
116637305
—
TX
05
—
116637306
—
TX
05
—
116637308
—
TX
01
—
1619080843
BLUE CROSS BLUE SHIELD
TX
01
—
P00958397
MEDICARE RR
TX
01
—
P01030497
RR MEDICARE
TX
Enumeration date
08/15/2006
Last updated
07/14/2014
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