Healthcare Provider Details

I. General information

NPI: 1679669576
Provider Name (Legal Business Name): LAURETTE DEKAT KUGELMANN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURETTE KATHRYN DEKAT MD, MPH

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 E NORTHGATE DR UNIVERSITY OF DALLAS STUDENT HEALTH CENTER
IRVING TX
75062-4736
US

IV. Provider business mailing address

6138 NORTHAVEN RD
DALLAS TX
75230-2944
US

V. Phone/Fax

Practice location:
  • Phone: 972-721-5322
  • Fax: 972-721-5124
Mailing address:
  • Phone: 214-987-2348
  • Fax: 972-721-5124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG4969
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: