Provider Demographics
NPI: | 1194793851 |
---|---|
Name: | VEJLANI, MUSTANSIR (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | MUSTANSIR |
Middle Name: | |
Last Name: | VEJLANI |
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: | 721 JAMES ST |
Mailing Address - Street 2: | |
Mailing Address - City: | TOMBALL |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77375-4537 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 281-351-5600 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 721 JAMES ST |
Practice Address - Street 2: | |
Practice Address - City: | TOMBALL |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77375-4537 |
Practice Address - Country: | US |
Practice Address - Phone: | 281-351-5600 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-03-09 |
Last Update Date: | 2022-08-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | K1116 | 207RP1001X, 207QS1201X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207QS1201X | Allopathic & Osteopathic Physicians | Family Medicine | Sleep Medicine |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 152796201 | Medicaid | |
TX | 826B47 | Other | MEDICARE GROUP NUMBER |
TX | 826B47 | Other | MEDICARE GROUP NUMBER |
TX | 152796201 | Medicaid |