Provider Demographics
NPI:1174277412
Name:BLUEBONNET OSR ASSOCIATES
Entity Type:Organization
Organization Name:BLUEBONNET OSR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MANSI
Authorized Official - Middle Name:
Authorized Official - Last Name:LALWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-825-5879
Mailing Address - Street 1:450 S DENTON TAP RD UNIT 442
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-7117
Mailing Address - Country:US
Mailing Address - Phone:216-825-5879
Mailing Address - Fax:
Practice Address - Street 1:7750 N. MACARTHUR BLVD. SUITE 120
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063
Practice Address - Country:US
Practice Address - Phone:216-825-5879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty