Provider Demographics
NPI:1083156426
Name:WAHEEDA MITHANI, MD, PLLC
Entity Type:Organization
Organization Name:WAHEEDA MITHANI, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:WAHEEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-721-6364
Mailing Address - Street 1:3820 HIGHWAY 365 STE 200
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-7565
Mailing Address - Country:US
Mailing Address - Phone:409-721-6364
Mailing Address - Fax:409-721-5012
Practice Address - Street 1:3820 HIGHWAY 365 STE 200
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7565
Practice Address - Country:US
Practice Address - Phone:409-721-6364
Practice Address - Fax:409-721-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3408174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty