Provider Demographics
NPI:1740552736
Name:MANISH DIMRI MD PA
Entity type:Organization
Organization Name:MANISH DIMRI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-559-4657
Mailing Address - Street 1:4817 RANGEWOOD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2630
Mailing Address - Country:US
Mailing Address - Phone:432-559-4657
Mailing Address - Fax:
Practice Address - Street 1:4817 RANGEWOOD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2630
Practice Address - Country:US
Practice Address - Phone:432-559-4657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3929207Q00000X
TXM5134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty