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General NPI Number Information
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NPI Number | 1063698967
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Entity Type | Individual
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Provider Name | KARTHIKEYANI KATHIRESAN MD
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Gender | Female
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 2301 S CLEAR CREEK RD #106
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City | KILLEEN
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State | TX
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Zip | 76549-4110
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Country | US
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Telephone | 254-526-2343
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Fax | 254-526-1084
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Provider Business Mailing Address
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Address Line | PO BOX 1658
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City | SAN ANTONIO
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State | TX
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Zip | 78296-1658
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Country | US
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Telephone | 254-526-2343
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Fax | 254-526-1084
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | BP2002029780
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | M8753
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License Number State | TX
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