Provider Demographics
NPI:1033285432
Name:JALEEL, MAMBARAMBATH A (MD)
Entity type:Individual
Prefix:DR
First Name:MAMBARAMBATH
Middle Name:A
Last Name:JALEEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAMBARATH
Other - Middle Name:A
Other - Last Name:JALEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-590-6500
Mailing Address - Fax:214-590-2755
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-590-6500
Practice Address - Fax:214-590-2755
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5247208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185930801Medicaid
TX8J4512Medicare PIN