Healthcare Provider Details

I. General information

NPI: 1467467985
Provider Name (Legal Business Name): LILAH S. MANSOUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 MEDICAL PKWY STE 200
CEDAR PARK TX
78613-2778
US

IV. Provider business mailing address

4515 SETON CENTER PKWY STE 215
AUSTIN TX
78759-5785
US

V. Phone/Fax

Practice location:
  • Phone: 512-341-0900
  • Fax:
Mailing address:
  • Phone: 512-338-3802
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberN5835
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: