Provider Demographics
NPI:1790328979
Name:MANALI HEALTHCARE PLLC
Entity Type:Organization
Organization Name:MANALI HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AROON
Authorized Official - Middle Name:
Authorized Official - Last Name:KALAKUNJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-558-4769
Mailing Address - Street 1:1014 HANOVER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6913 CAMP BOWIE BLVD STE 171
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7165
Practice Address - Country:US
Practice Address - Phone:682-558-4769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1801857636OtherNPI INDIVIDUAL