Healthcare Provider Details

I. General information

NPI: 1356755680
Provider Name (Legal Business Name): LAUREN MARIE KASTNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2014
Last Update Date: 06/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE 1013
DALLAS TX
75246-2017
US

IV. Provider business mailing address

3500 GASTON AVE 1013
DALLAS TX
75246-2017
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-2362
  • Fax: 214-820-7272
Mailing address:
  • Phone: 214-820-2362
  • Fax: 214-820-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10050978
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: