MEDICARE: KATHLEEN R MCDONALD 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	207Y00000X	Otolaryngology Physician	K0125	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB166198	OTHER	TX	MEDICARE - GROUP#

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558344077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN R MCDONALD MD

Provider Business Mailing Address
First Line	:	14140 SOUTHWEST FWY STE 200
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3842
Country	:	US
Telephone Number	:	281-649-7000
Fax Number	:	713-484-6649

Provider Business Practice Location Address
First Line	:	11914 ASTORIA BLVD
Second Line	:	#360
City	:	HOUSTON
State	:	TX
Zip	:	77089-6064
Country	:	US
Telephone Number	:	281-484-3981
Fax Number	:	281-481-0182

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	05/10/2022

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