Provider Demographics
NPI:1275732976
Name:KHOSHNEJAD, MANI (MD)
Entity Type:Individual
Prefix:
First Name:MANI
Middle Name:
Last Name:KHOSHNEJAD
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 1:2223 ROLLINGBROOK DR.
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:281-420-3565
Mailing Address - Fax:281-427-7808
Practice Address - Street 1:2223 ROLLINGBROOK DR.
Practice Address - Street 2:SUITE 125
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:281-420-3565
Practice Address - Fax:281-427-7808
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine