Provider Demographics
NPI:1891735684
Name:LAPSIWALA, SAMIR B (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:B
Last Name:LAPSIWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1900 MISTLETOE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4049
Mailing Address - Country:US
Mailing Address - Phone:817-878-5333
Mailing Address - Fax:817-878-5334
Practice Address - Street 1:1900 MISTLETOE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4049
Practice Address - Country:US
Practice Address - Phone:817-878-5333
Practice Address - Fax:817-878-5334
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1377207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202795501Medicaid
OH2606148Medicaid
OHH43712Medicare UPIN
TX202795501Medicaid