Basic Information
| Provider Information | |||||||||
| NPI: | 1578597324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHALAN | ||||||||
| FirstName: | NABEEL | ||||||||
| MiddleName: | KAMAL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 996 | ||||||||
| Address2: | |||||||||
| City: | HAYDEN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838350996 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086644026 | ||||||||
| FaxNumber: | 2086644840 | ||||||||
| Practice Location | |||||||||
| Address1: | 7500 BEECHNUT | ||||||||
| Address2: | SUITE 265 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770744335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139811500 | ||||||||
| FaxNumber: | 7139811504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 05/04/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | L8504 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 198233201 | 05 | TX | MEDICAID | 8X9510 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |