Individual
KOUSHIK K. SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12319 N MOPAC EXPY, SUITE 200, AUSTIN, TX 78758-2414
(512) 694-8888
(512) 973-3036
Mailing address
12319 N MOPAC EXPY, SUITE 200, AUSTIN, TX 78758-2414
(512) 694-8888
(512) 973-3036
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
M0272
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170313401
—
TX
01
—
P00196306
RRMCR
TX
Enumeration date
04/27/2006
Last updated
06/12/2013
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