Provider Demographics
NPI:1164866455
Name:KESTURKOPPAL MURALIDHARA MD, PA
Entity Type:Organization
Organization Name:KESTURKOPPAL MURALIDHARA MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KESTURKOPPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MURALIDHARA
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:956-225-2401
Mailing Address - Street 1:300 S 2ND ST
Mailing Address - Street 2:STE. 105-B
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2702
Mailing Address - Country:US
Mailing Address - Phone:956-225-2401
Mailing Address - Fax:888-794-8753
Practice Address - Street 1:300 S 2ND ST
Practice Address - Street 2:STE. 105-B
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2702
Practice Address - Country:US
Practice Address - Phone:956-225-2401
Practice Address - Fax:888-794-8753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215664802Medicaid
TX296117901Medicaid
TX1164866455Medicaid
TX296117902Medicaid
TX296117901Medicaid