Provider Demographics
NPI:1528054046
Name:SHIRVANI, ALI R (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:R
Last Name:SHIRVANI
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 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1812
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:4325 N JOSEY LN STE 206
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4637
Practice Address - Country:US
Practice Address - Phone:214-915-8515
Practice Address - Fax:469-892-2312
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7848208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX575375YNEDOtherMEDICARE DALLAS
TX575372YND4OtherMEDICARE 99
TX575372YNECOtherMEDICARE - TARRANT
TX030698708Medicaid
TX575372YNECOtherMEDICARE - TARRANT
TXF96927Medicare UPIN
TX575372YND4OtherMEDICARE 99
TX8467B6Medicare PIN
TX030698704Medicaid
TX030698707Medicaid