Healthcare Provider Details

I. General information

NPI: 1508067760
Provider Name (Legal Business Name): KATRINA PAULINE BIRDWELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA PAULINE EMMETT M.D

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W COLORADO BLVD PAV II, SUITE 532
DALLAS TX
75208-2363
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 214-943-8605
  • Fax: 214-946-8339
Mailing address:
  • Phone: 972-997-8000
  • Fax: 972-234-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP0580
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberP0580
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: