Provider Demographics
NPI:1730168626
Name:SHRIDHARANI, SHYAM M (MD)
Entity type:Individual
Prefix:
First Name:SHYAM
Middle Name:M
Last Name:SHRIDHARANI
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 1:20375 W 151ST ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5353
Mailing Address - Country:US
Mailing Address - Phone:913-355-8100
Mailing Address - Fax:913-303-5510
Practice Address - Street 1:20375 W 151ST ST STE 105
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5353
Practice Address - Country:US
Practice Address - Phone:913-355-8100
Practice Address - Fax:913-303-5510
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46861207XS0117X, 207X00000X
KS04-43974207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201331390AMedicaid
159921ZAKWOtherMARYLAND MEDICARE
462LOtherMARYLAND MEDICARE
46950041OtherCAREFIRST NCA
164115YZWOtherDC MEDICARE
176608OtherDC MEDICARE
95676601OtherCAREFIRST MARYLAND
MN263606900Medicaid
I11715Medicare UPIN
0254450002Medicare NSC
95676601OtherCAREFIRST MARYLAND
0254450001Medicare NSC
CI2264Medicare PIN