Provider Demographics
NPI:1467467985
Name:MANSOUR, LILAH S (MD)
Entity Type:Individual
Prefix:
First Name:LILAH
Middle Name:S
Last Name:MANSOUR
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 1:4515 SETON CENTER PKWY STE 215
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5785
Mailing Address - Country:US
Mailing Address - Phone:512-338-3802
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1411 MEDICAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2778
Practice Address - Country:US
Practice Address - Phone:512-341-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5835207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2164568-01Medicaid
TX8CL139OtherBCBS IND. NUMBER
TX336807YKXYOtherMEDICARE PTAN
TX216456803Medicaid
TX216456802Medicaid
TX336807YKXVOtherMEDICARE PTAN
TX336807YKXYOtherMEDICARE PTAN
TX336807YKXVOtherMEDICARE PTAN