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Organization
KANER MEDICAL GROUP PA
Active
Organization
KANER MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH KUTLER (CEO)
(817) 358-5800
Entity
Organization
Contact information
Practice address
1305 AIRPORT FWY, STE 220, BEDFORD, TX 76021-6605
(817) 358-5800
(817) 283-7686
Mailing address
PO BOX 210907, KANER MEDICAL GROUP PA, BEDFORD, TX 76095-7907
(817) 358-5800
(817) 283-7686
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155952801
—
TX
Enumeration date
10/25/2005
Last updated
04/09/2008
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