Provider Demographics
NPI:1689137515
Name:MANSI, TAREK (MD)
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:
Last Name:MANSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 MEDICAL DISTRICT DR APT 4325
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-8055
Mailing Address - Country:US
Mailing Address - Phone:312-825-3622
Mailing Address - Fax:
Practice Address - Street 1:2222 MEDICAL DISTRICT DR APT 4325
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235
Practice Address - Country:US
Practice Address - Phone:312-825-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program