Provider Demographics
NPI:1801287974
Name:PATHFINDER MEDICAL GROUP OF TEXAS
Entity type:Organization
Organization Name:PATHFINDER MEDICAL GROUP OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-915-6389
Mailing Address - Street 1:272 E DEERPATH
Mailing Address - Street 2:STE 204
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-5314
Mailing Address - Country:US
Mailing Address - Phone:847-915-6389
Mailing Address - Fax:847-686-2020
Practice Address - Street 1:2950 NORTH LOOP W
Practice Address - Street 2:STE 500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8843
Practice Address - Country:US
Practice Address - Phone:847-915-6389
Practice Address - Fax:847-686-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty