Healthcare Provider Details

I. General information

NPI: 1568457968
Provider Name (Legal Business Name): SAVITA R KURUP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 HARRIS PKWY
FORT WORTH TX
76132-4101
US

IV. Provider business mailing address

12417 BELLA VINO DR
FORT WORTH TX
76126-4929
US

V. Phone/Fax

Practice location:
  • Phone: 817-433-5977
  • Fax: 817-433-5989
Mailing address:
  • Phone: 817-239-1071
  • Fax: 817-782-9468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61367487
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL2394
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: