Healthcare Provider Details

I. General information

NPI: 1528060241
Provider Name (Legal Business Name): WILLIAM THOMAS KITTLEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 ROUND ROCK AVE STE 100
ROUND ROCK TX
78681-4010
US

IV. Provider business mailing address

2120 ROUND ROCK AVE STE 100
ROUND ROCK TX
78681-4010
US

V. Phone/Fax

Practice location:
  • Phone: 502-244-1991
  • Fax: 512-244-1786
Mailing address:
  • Phone: 502-244-1991
  • Fax: 512-244-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberF9675
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: