Provider Demographics
NPI:1376047837
Name:MITHANI, MOEZ (MD)
Entity type:Individual
Prefix:DR
First Name:MOEZ
Middle Name:
Last Name:MITHANI
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 1:20079 STONE OAK PKWY STE 1245
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-6957
Mailing Address - Country:US
Mailing Address - Phone:210-545-0087
Mailing Address - Fax:210-545-3455
Practice Address - Street 1:20079 STONE OAK PKWY STE 1245
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-6957
Practice Address - Country:US
Practice Address - Phone:210-545-0087
Practice Address - Fax:210-545-3455
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61258608207L00000X
WI4373-320207L00000X
TXV1351208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100277814Medicaid