Provider Demographics
NPI:1760674253
Name:SANDEEP G. MISTRY, MD, PA
Entity type:Organization
Organization Name:SANDEEP G. MISTRY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:G
Authorized Official - Last Name:MISTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-238-0762
Mailing Address - Street 1:1000 HESTERS CROSSING
Mailing Address - Street 2:STE 300
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681
Mailing Address - Country:US
Mailing Address - Phone:512-238-0762
Mailing Address - Fax:512-341-7370
Practice Address - Street 1:1000 HESTERS CROSSING
Practice Address - Street 2:STE 300
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681
Practice Address - Country:US
Practice Address - Phone:512-238-0762
Practice Address - Fax:512-341-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0182208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty