Provider Demographics
NPI:1861706079
Name:AKVAN, SHAHAB (MD)
Entity type:Individual
Prefix:
First Name:SHAHAB
Middle Name:
Last Name:AKVAN
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 1:2101 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4133
Mailing Address - Country:US
Mailing Address - Phone:940-766-3190
Mailing Address - Fax:940-687-1617
Practice Address - Street 1:2101 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4133
Practice Address - Country:US
Practice Address - Phone:940-766-3190
Practice Address - Fax:940-687-1617
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT-193206208600000X
TXQ8197208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery