Provider Demographics
NPI:1720304298
Name:MUDALIAR, KUMARAN (MD)
Entity Type:Individual
Prefix:
First Name:KUMARAN
Middle Name:
Last Name:MUDALIAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1441 NORTH BECKLEY AVE
Mailing Address - Street 2:PATHOLOGY DEPARTMENT
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1201
Mailing Address - Country:US
Mailing Address - Phone:214-947-8181
Mailing Address - Fax:708-327-2620
Practice Address - Street 1:1441 NORTH BECKLEY AVE
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1201
Practice Address - Country:US
Practice Address - Phone:214-947-8181
Practice Address - Fax:708-327-2620
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT4227207ND0900X, 207ZP0102X
IL036.132976207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology