Provider Demographics
NPI:1528683141
Name:MANIVANNAN, MEENAKSHI (MD)
Entity type:Individual
Prefix:DR
First Name:MEENAKSHI
Middle Name:
Last Name:MANIVANNAN
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 1:1790 N STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7437
Mailing Address - Country:US
Mailing Address - Phone:972-390-9002
Mailing Address - Fax:972-984-7988
Practice Address - Street 1:2548 LILLIAN MILLER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-7212
Practice Address - Country:US
Practice Address - Phone:940-387-7565
Practice Address - Fax:940-566-0574
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU9026207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology