Basic Information
| Provider Information | |||||||||
| NPI: | 1770504136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIVNANI | ||||||||
| FirstName: | ANAND | ||||||||
| MiddleName: | THANWAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9724379605 | ||||||||
| Practice Location | |||||||||
| Address1: | 7777 FOREST LANE | ||||||||
| Address2: | BUILDING D, SUITE 110 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725667031 | ||||||||
| FaxNumber: | 9725667942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 10/19/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 4301077697 | MI | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 182606706 | 05 | TX | MEDICAID | 200104380A | 05 | OK | MEDICAID | 182606701 | 05 | TX | MEDICAID | 182606705 | 05 | TX | MEDICAID | 182606708 | 05 | TX | MEDICAID | 182606709 | 05 | TX | MEDICAID | 182606704 | 05 | TX | MEDICAID | 182606703 | 05 | TX | MEDICAID | 182606707 | 05 | TX | MEDICAID |