Individual
MYTHILI PALADUGU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
851 W TERRELL AVE, FORT WORTH, TX 76104-3161
(817) 332-8346
(817) 332-1723
Mailing address
PO BOX 33434, FORT WORTH, TX 76162-3434
(817) 332-8346
(817) 332-1723
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
M6326
TX
207L00000X
Anesthesiology Physician
Primary
M6326
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197922103
—
TX
Enumeration date
11/13/2006
Last updated
01/30/2024
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