Provider Demographics
NPI:1417211632
Name:MANGAT, PREET GURINDER KAUR (MD)
Entity Type:Individual
Prefix:DR
First Name:PREET GURINDER
Middle Name:KAUR
Last Name:MANGAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PREET
Other - Middle Name:KAUR
Other - Last Name:MANGAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1385
Mailing Address - Country:US
Mailing Address - Phone:409-772-2166
Mailing Address - Fax:409-772-2663
Practice Address - Street 1:1492 S. MILL AVE
Practice Address - Street 2:SUITE NO. 312
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10043712207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine