Provider Demographics
NPI:1225046360
Name:MANI, RAVI S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:S
Last Name:MANI
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 1:1015 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4011
Mailing Address - Country:US
Mailing Address - Phone:281-404-0360
Mailing Address - Fax:281-480-4046
Practice Address - Street 1:1015 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 1700
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4011
Practice Address - Country:US
Practice Address - Phone:281-404-0360
Practice Address - Fax:281-480-4046
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0110207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100010838OtherMEDICARE RAILROAD
TX127647906Medicaid
TX4071898OtherAETNA PROVIDER NUMBER
TX799OtherMHHNP
TX8436K0OtherBCBS PROVIDER #
TX127647906Medicaid
TX100010838OtherMEDICARE RAILROAD