Provider Demographics
NPI:1912915034
Name:KASAL, NATARAJ G (MD)
Entity Type:Individual
Prefix:DR
First Name:NATARAJ
Middle Name:G
Last Name:KASAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 RIDGLEA PL STE 1103
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5737
Mailing Address - Country:US
Mailing Address - Phone:817-926-9087
Mailing Address - Fax:
Practice Address - Street 1:6300 RIDGLEA PL STE 1103
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5737
Practice Address - Country:US
Practice Address - Phone:817-926-9087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.142309207RG0100X
IN01076607A207RG0100X
TXE5808207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00160992OtherMEDICARE RAILROAD
TX0856858-01Medicaid
TX84Z770Medicare PIN
TXB23851Medicare UPIN