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General NPI Number Information
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NPI Number | 1669641254
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Entity Type | Individual
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Provider Name | MYTHILI KASTURI M.D
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Gender | Female
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | AUSTIN REGIONAL CLINIC 12779 TX- 29
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City | LIBERTY HILL
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State | TX
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Zip | 78642
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Country | US
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Telephone | 512-778-7003
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Fax |
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Provider Business Mailing Address
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Address Line | 6210 E HWY 290 STE 240
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City | AUSTIN
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State | TX
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Zip | 78723-1144
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301088208
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 55672
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | Q5831
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License Number State | TX
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