Provider Demographics
NPI:1568732022
Name:BEYRAU, KATHLEEN K (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:K
Last Name:BEYRAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11881 PEBBLEPOINTE PASS
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-9672
Mailing Address - Country:US
Mailing Address - Phone:317-417-0410
Mailing Address - Fax:
Practice Address - Street 1:6201 SOUTH FWY
Practice Address - Street 2:AB 2-6
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-2001
Practice Address - Country:US
Practice Address - Phone:817-568-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050723A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology