Provider Demographics
NPI:1669641254
Name:KASTURI, MYTHILI (MD)
Entity Type:Individual
Prefix:DR
First Name:MYTHILI
Middle Name:
Last Name:KASTURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MYTHILI
Other - Middle Name:
Other - Last Name:KOMMIRSHETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 W CENTRAL TEXAS EXPY STE 125
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1996
Mailing Address - Country:US
Mailing Address - Phone:254-618-1050
Mailing Address - Fax:254-618-1058
Practice Address - Street 1:800 W CENTRAL TEXAS EXPY STE 125
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1996
Practice Address - Country:US
Practice Address - Phone:254-618-1050
Practice Address - Fax:254-618-1058
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088208207Q00000X
MN55672207Q00000X
TXQ5831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine