Provider Demographics
NPI:1386430379
Name:GULLABZADA, MANSOOR (MD)
Entity type:Individual
Prefix:DR
First Name:MANSOOR
Middle Name:
Last Name:GULLABZADA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 ST MARY'S DRIVE EAST
Mailing Address - Street 2:MOB SUITE 510
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714
Mailing Address - Country:US
Mailing Address - Phone:812-485-5990
Mailing Address - Fax:
Practice Address - Street 1:801 ST MARY'S DRIVE EAST
Practice Address - Street 2:MOB SUITE 510
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714
Practice Address - Country:US
Practice Address - Phone:812-485-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program