Provider Demographics
NPI:1457348963
Name:WANI, MANISH K (MD)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:K
Last Name:WANI
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 1:10740 N GESSNER DR
Mailing Address - Street 2:STE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:18400 KATY FWY
Practice Address - Street 2:STE 470
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094
Practice Address - Country:US
Practice Address - Phone:281-492-7827
Practice Address - Fax:281-646-1416
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2051207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1115016OtherBEECHSTREET
TX144649402Medicaid
TX144649401Medicaid
TX144649401Medicaid
TX81448NMedicare PIN
TXG42528Medicare UPIN
TX144649402Medicaid