Individual
DR. KATHRYN KOHELI MANDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9509 NORTH BEACH STREET, SUITE 102, FORT WORTH, TX 76244-6399
(817) 617-8650
(877) 906-1852
Mailing address
9509 NORTH BEACH STREET, SUITE 102, FORT WORTH, TX 76244-6399
(817) 617-8650
(877) 906-1852
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M5344
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0046KV
BCBS GROUP
—
05
—
165592001
—
TX
01
—
17100066598
KELLER GROUP NPI
—
01
—
8K6668
BCBS
TX
Enumeration date
11/21/2006
Last updated
09/01/2016
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