Provider Demographics
NPI:1346360997
Name:MUSTAFA MANDVIWALA, MD, PA
Entity Type:Organization
Organization Name:MUSTAFA MANDVIWALA, MD, PA
Other - Org Name:NORTHWEST HEART CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:SAJJAD
Authorized Official - Last Name:MANDVIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-351-6250
Mailing Address - Street 1:13406 MEDICAL COMPLEX DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3332
Mailing Address - Country:US
Mailing Address - Phone:281-351-6250
Mailing Address - Fax:281-351-7841
Practice Address - Street 1:13406 MEDICAL COMPLEX DR
Practice Address - Street 2:SUITE 110
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3332
Practice Address - Country:US
Practice Address - Phone:281-351-6250
Practice Address - Fax:281-351-7841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG29884Medicare UPIN
TXB24600Medicare UPIN
TXG34009Medicare UPIN
TXP43181Medicare UPIN