Provider Demographics
NPI:1679774459
Name:SHIRODKAR, SAMIR PRADEEP (MD)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:PRADEEP
Last Name:SHIRODKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9305 PINECROFT DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3482
Mailing Address - Country:US
Mailing Address - Phone:936-441-1005
Mailing Address - Fax:936-521-1138
Practice Address - Street 1:9305 PINECROFT DR
Practice Address - Street 2:SUITE 104
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3482
Practice Address - Country:US
Practice Address - Phone:936-441-1005
Practice Address - Fax:936-521-1138
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN9644208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094010801OtherGROUP MEDICAID NUMBER
TX00J21AOtherGROUP MEDICARE NUMBER