Healthcare Provider Details

I. General information

NPI: 1699039909
Provider Name (Legal Business Name): AMEETA KATDARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31303 FM 2920 RD SUITE G
WALLER TX
77484-8197
US

IV. Provider business mailing address

1 HERMANN MUSEUM CIRCLE DR APT 4079
HOUSTON TX
77004-7174
US

V. Phone/Fax

Practice location:
  • Phone: 936-931-3448
  • Fax: 936-931-3704
Mailing address:
  • Phone: 713-598-2499
  • Fax: 936-931-3704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP2698
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: