Provider Demographics
NPI:1255393302
Name:SVATEK, MANDIE ALICE TIBBALL (MD)
Entity type:Individual
Prefix:
First Name:MANDIE
Middle Name:ALICE TIBBALL
Last Name:SVATEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANDIE
Other - Middle Name:ALICE
Other - Last Name:TIBBALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7703 FLOYD CURL DR # MC7977
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-9000
Mailing Address - Fax:
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-450-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0585208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175438405Medicaid
TX175438406OtherCSHCN
TX175438401Medicaid
8W7649OtherBCBSTX
I37045Medicare UPIN