Healthcare Provider Details

I. General information

NPI: 1942308804
Provider Name (Legal Business Name): NANDINI D KOHLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR BLDG II, SUITE 300
AUSTIN TX
78758-5387
US

IV. Provider business mailing address

2200 PARK BEND DR BLDG. II, SUITE 300
AUSTIN TX
78758-5387
US

V. Phone/Fax

Practice location:
  • Phone: 512-836-5665
  • Fax: 512-997-9092
Mailing address:
  • Phone: 512-836-5665
  • Fax: 512-997-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL2969
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: