=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659731461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANISH NAIR MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2016
-----------------------------------------------------
Last Update Date | 03/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6705 SHADY BEND LN
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-6088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-755-6874
-----------------------------------------------------
Fax | 817-622-8068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6705 SHADY BEND LN
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-6088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-755-6874
-----------------------------------------------------
Fax | 817-622-8068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MANISH NAIR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 214-755-6874
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 45669
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | Q5232
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------