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NPI Code Detail

MEDICARE: DR. KATHRYN KOHELI MANDAL M.D.

MEDICARE: DR. KATHRYN KOHELI MANDAL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianM5344TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10046KVOTHERBCBS GROUP
28K6668OTHERTXBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
417100066598OTHERKELLER GROUP NPI

General Provider Information

NPI Number : 1134294796
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHRYN KOHELI MANDAL M.D.
Provider Business Mailing Address
First Line : 9509 NORTH BEACH STREET
Second Line : SUITE 102
City : FORT WORTH
State : TX
Zip : 76244-6399
Country : US
Telephone Number : 817-617-8650
Fax Number : 877-906-1852
Provider Business Practice Location Address
First Line : 9509 NORTH BEACH STREET
Second Line : SUITE 102
City : FORT WORTH
State : TX
Zip : 76244-6399
Country : US
Telephone Number : 817-617-8650
Fax Number : 877-906-1852
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2006
Last Update Date : 09/01/2016

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