Provider Demographics
NPI:1417900895
Name:MIAN, MANSOOR MUHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSOOR
Middle Name:MUHAMMAD
Last Name:MIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MUHAMMAD
Other - Middle Name:MANSOOR
Other - Last Name:MIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1505 REATA DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-1153
Mailing Address - Country:US
Mailing Address - Phone:972-375-7821
Mailing Address - Fax:682-200-2850
Practice Address - Street 1:1505 REATA DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-1153
Practice Address - Country:US
Practice Address - Phone:972-375-7821
Practice Address - Fax:682-200-2850
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL81332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG20763Medicare UPIN