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 1:6210 E HWY 290 STE 240
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AUSTIN REGIONAL CLINIC
Practice Address - Street 2:12779 TX- 29
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642
Practice Address - Country:US
Practice Address - Phone:512-778-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088208207Q00000X
MN55672207Q00000X
TXQ5831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine