Provider Demographics
NPI:1497952253
Name:MITHANI, WAHEEDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:WAHEEDA
Middle Name:
Last Name:MITHANI
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 1:3820 HWY. 365, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642
Mailing Address - Country:US
Mailing Address - Phone:409-721-5150
Mailing Address - Fax:409-721-6102
Practice Address - Street 1:3820 HWY. 365, SUITE 200
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642
Practice Address - Country:US
Practice Address - Phone:409-721-5150
Practice Address - Fax:409-721-6102
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08938600208600000X
TXQ3408208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery