Provider Demographics
NPI:1891186078
Name:TAJNERT, KATHRENE A (MD)
Entity Type:Individual
Prefix:
First Name:KATHRENE
Middle Name:A
Last Name:TAJNERT
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 1:431 E STATE HIGHWAY 114 STE 300
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1484
Mailing Address - Country:US
Mailing Address - Phone:817-251-6500
Mailing Address - Fax:
Practice Address - Street 1:431 E STATE HIGHWAY 114 STE 300
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:817-251-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7605207N00000X
IL125065943207N00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology