MEDICARE: KADRIYE MELTEM KORAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2085R0202X	Diagnostic Radiology Physician	298162-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BP3-0021149	OTHER		INSTITUTIONAL PERMIT

General Provider Information

NPI Number	:	1508060674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KADRIYE MELTEM KORAL MD

Provider Business Mailing Address
First Line	:	4500 S. LANCASTER RD.
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	DALLAS
State	:	TX
Zip	:	75216-7167
Country	:	US
Telephone Number	:	214-857-0185
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 S. LANCASTER RD.
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	DALLAS
State	:	TX
Zip	:	75216-7521
Country	:	US
Telephone Number	:	214-857-0185
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	04/24/2019

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