MEDICARE: KATHY POULIN MD

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
1	207Q00000X	Family Medicine Physician	15342	ZZ

General Provider Information

NPI Number	:	1326893223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY POULIN MD

Provider Business Mailing Address
First Line	:	2801 S LAKELINE BLVD APT 4204
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-1778
Country	:	US
Telephone Number	:	973-310-2799
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 S LAKELINE BLVD APT 4204
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-1778
Country	:	US
Telephone Number	:	973-310-2799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	04/23/2024

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