Provider Demographics
NPI:1053776856
Name:SYED MANSOOR HUSSAINI MD PA
Entity type:Organization
Organization Name:SYED MANSOOR HUSSAINI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:MANSOOR
Authorized Official - Last Name:HUSSAINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:469-615-1183
Mailing Address - Street 1:PO BOX 453202
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75045-3202
Mailing Address - Country:US
Mailing Address - Phone:469-615-1183
Mailing Address - Fax:469-786-5780
Practice Address - Street 1:6701 HERITAGE PKWY STE 165
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8700
Practice Address - Country:US
Practice Address - Phone:469-786-5890
Practice Address - Fax:469-786-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ18322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty