Provider Demographics
NPI:1780651133
Name:RANGAN, MYTHILI NMN (MD)
Entity type:Individual
Prefix:DR
First Name:MYTHILI
Middle Name:NMN
Last Name:RANGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11840 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3840
Mailing Address - Country:US
Mailing Address - Phone:832-912-7044
Mailing Address - Fax:832-912-7033
Practice Address - Street 1:27721 STATE HIGHWAY 249
Practice Address - Street 2:SUITE 100
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3332
Practice Address - Country:US
Practice Address - Phone:281-357-5115
Practice Address - Fax:281-516-9466
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1168208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760608874OtherTAX ID#
TX035826904Medicaid
TX035826902Medicaid
TX035826902Medicaid