Provider Demographics
NPI:1871791590
Name:BADIYAN, SHAMIM JUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAMIM
Middle Name:JUSTIN
Last Name:BADIYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHAMIM
Other - Middle Name:
Other - Last Name:SHAKOURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11500 HIGHWAY 121
Mailing Address - Street 2:STE. 1010
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:972-219-8400
Mailing Address - Fax:972-219-5331
Practice Address - Street 1:11500 HIGHWAY 121
Practice Address - Street 2:STE. 1010
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:972-219-8400
Practice Address - Fax:972-219-5331
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8075207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CY297OtherBCBS
TX287577501Medicaid
TX287577503Medicaid
TX287577502Medicaid
TXTXB136552Medicare PIN
TX8CY297OtherBCBS
TX287577501Medicaid