Provider Demographics
NPI:1336382068
Name:MITHANI, TAMANNA (DO)
Entity Type:Individual
Prefix:
First Name:TAMANNA
Middle Name:
Last Name:MITHANI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 LBJ FREEWAY SUITE 900
Mailing Address - Street 2:HERITAGE SQUARE ONE
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BSW LAKEPOINTE
Practice Address - Street 2:6800 SCENIC DRIVE
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088
Practice Address - Country:US
Practice Address - Phone:972-520-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2175207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine