Provider Demographics
NPI:1336134105
Name:MISRA, MEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MEEN
Middle Name:
Last Name:MISRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:AUSTIN DIAGNOSTIC CLINIC
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4009
Mailing Address - Fax:512-901-3909
Practice Address - Street 1:12221 N MOPAC EXPY
Practice Address - Street 2:AUSTIN DIAGNOSTIC CLINIC
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4009
Practice Address - Fax:512-901-3909
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163011301Medicaid
TXP01077209OtherRRMC PTAN
TXTXB149807Medicare PIN
TXH98490Medicare UPIN
TX163011301Medicaid