Provider Demographics
NPI:1174572077
Name:SANI, SHAHRAM NOROUZI (MD)
Entity type:Individual
Prefix:
First Name:SHAHRAM
Middle Name:NOROUZI
Last Name:SANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9540 GARLAND RD. #381-251
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-5004
Mailing Address - Country:US
Mailing Address - Phone:469-200-4623
Mailing Address - Fax:469-213-2782
Practice Address - Street 1:1151 N. BUCKNER BLVD.
Practice Address - Street 2:STE. 403
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3407
Practice Address - Country:US
Practice Address - Phone:469-200-4623
Practice Address - Fax:469-213-2782
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035815207R00000X
TXP6074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX321435511Medicaid