Healthcare Provider Details

I. General information

NPI: 1215949169
Provider Name (Legal Business Name): PADMA KROTHAPALLI HORVIT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 06/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 HYMEADOW DR BUILDING 1 SUITE C
AUSTIN TX
78750-2263
US

IV. Provider business mailing address

12501 HYMEADOW DR BUILDING 1 SUITE C
AUSTIN TX
78750-2263
US

V. Phone/Fax

Practice location:
  • Phone: 512-258-2556
  • Fax: 512-258-8408
Mailing address:
  • Phone: 512-258-2556
  • Fax: 512-258-8408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberJ4218
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: