=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245215516
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANISH SAGARMAL CHAUHAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2005
-----------------------------------------------------
Last Update Date | 01/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 PARK BEND DR BLDG. 2 SUITE 300
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78758-5387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-617-6000
-----------------------------------------------------
Fax | 512-339-7838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2410 ROUND ROCK AVE STE 170
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78681-4002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-827-0927
-----------------------------------------------------
Fax | 512-827-0928
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | M0039
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------