Provider Demographics
NPI:1902942196
Name:SUBRAMANIAN, MANI (MD)
Entity type:Individual
Prefix:DR
First Name:MANI
Middle Name:
Last Name:SUBRAMANIAN
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 1:2207 S CLEAR CREEK RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4132
Mailing Address - Country:US
Mailing Address - Phone:254-526-5353
Mailing Address - Fax:254-554-5298
Practice Address - Street 1:2207 S CLEAR CREEK RD
Practice Address - Street 2:SUITE 302
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4132
Practice Address - Country:US
Practice Address - Phone:254-526-5353
Practice Address - Fax:254-554-5298
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4724207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1802217-01Medicaid
TX1802209-01Medicaid
TX8S4240OtherBCBSTX PROVIDER NUMBER
TX00271ZMedicare PIN
TXD69160Medicare UPIN
TX1802209-01Medicaid