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Individual

DR. SHYAM KISHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5680 FRISCO SQUARE BLVD STE 2500, FRISCO, TX 75034-3315
(972) 347-4783
(972) 347-4916
Mailing address
4128 FAIR MEADOWS DR, PLANO, TX 75024-3457

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01068071A
IN
207X00000X
Orthopaedic Surgery Physician
Primary
R1799
TX
207XP3100X
Pediatric Orthopaedic Surgery Physician
01068071A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000674113
ANTHEM PIN
IN
05
200994100
IN
05
375540701
TX
Enumeration date
01/24/2006
Last updated
01/04/2022
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