MARY K KUKOLICH


Address: 1300 W Lancaster Ave, Ste 204, Fort Worth, TX 76102-3410
Phone: 6828852170

MARY K KUKOLICH (NPI# 1912918111) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1912918111
Entity Type Individual
Full Name MARY K KUKOLICH
Credential MD
Practice Address 1300 W Lancaster Ave
Ste 204
Fort Worth
TX 76102-3410
Mailing Address Po Box 99371
Fort Worth
TX 76199-0371
Practice Telephone 6828852170
Practice Fax Number 8173358277
Mailing Telephone 6828851855
Mailing Fax Number 6828857347
Enumeration Date 2006-08-11
Last Update Date 2010-05-04
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207SG0201X Medical Genetics
Specialization: Clinical Genetics (M.D.)
E5817 TX Allopathic & Osteopathic Physicians
N 208000000X Pediatrics E5817 TX Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
TX 152676601 05
NPI GROUP NUMBER 1750369203 01
TX 139583221 05
TX 139583212 05
TX 139583219 05
TX 138412512 05
TX 138412513 05

Office Location

Street Address 1300 W LANCASTER AVE
STE 204
City FORT WORTH
State TX
Zip Code 76102-3410

Providers in the same location

NPI Name Taxonomy Address Enumeration
1841281318 Lesley M Drummond-borg Medical Genetics 1300 W Lancaster Ave, Ste 204, Fort Worth, TX 76102-3410 2005-11-02
1619508330 Melinda Robison Behavioral Analyst 1300 W Lancaster Ave, Fort Worth, TX 76102-3499 2020-01-31
1710421474 Kathryn Fruit Dietitian, Registered 1300 W Lancaster Ave, Ste 204, Fort Worth, TX 76102-3410 2016-12-14
1205219961 Joshua Jessel Behavioral Analyst 1300 W Lancaster Ave, Fort Worth, TX 76102-3410 2015-06-30
1053729525 Katherine Schaars Audiologist 1300 W Lancaster Ave, Ste 106, Fort Worth, TX 76102-3410 2014-07-29
1720420722 Jayme Stiller Nurse Practitioner 1300 W Lancaster Ave, Fort Worth, TX 76102-3410 2013-07-19
1922354166 Candace Nicole Gamble Medical Genetics 1300 W Lancaster Ave, Ste 204, Fort Worth, TX 76102-3410 2012-07-25
1710246343 Carla Michelle Smith Behavioral Analyst 1300 W Lancaster Ave, Fort Worth, TX 76102-3410 2012-05-16
1962709410 Einar Ingvarsson Behavioral Analyst 1300 W Lancaster Ave, Fort Worth, TX 76102-3410 2011-02-18
1275838088 Tina Grace Barbaro Dieber Medical Genetics 1300 W Lancaster Ave, Ste 204, Fort Worth, TX 76102-3410 2011-01-26
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1285113746 Deirdre P Browne Counselor 1500 E El Paso, Fort Worth, TX 76102 2018-08-07
1740784206 Cvs Pharmacy Inc Pharmacy 515 Houston St, Fort Worth, TX 76102 2018-03-20
1316448061 Diondra Deshawn Narcisse Licensed Vocational Nurse 1314 Lake Street, Fort Worth, TX 76102 2018-02-27
1649779943 Carmela A Solis Specialist/Technologist, Other 500 Throckmorton Street Unit 3309, Fort Worth, TX 76102 2018-02-02
1104324516 Vicki Webb-baker Health Educator 512 Lamar Street, Suite 400, Fort Worth, TX 76102 2018-01-31
1235647678 Brianna Marie Keister Occupational Therapist 201 W. Lancaster Ave, 417, Fort Worth, TX 76102 2018-01-19
1437507910 Medical Hearing Services, LLC Hearing Aid Equipment 1201 Summit Avenue, Fort Worth, TX 76102 2016-05-25
1891171476 Karis Starke Physical Therapy Assistant 2500 West Freeway (i-30), 100, Fort Worth, TX 76102 2015-08-05
1265839344 Fm Katy Dental and Orthodontics, Pllc Dentist 100 E 15th Ste 520, Fort Worth, TX 76102 2014-12-04
1093134512 Superior Evaluation Services General Practice 420 Throckmorton Suite 200, Ft. Worth, TX 76102 2014-04-11
Find all providers in zip 76102

Taxonomy Information

Taxonomy Code 207SG0201X
Grouping Allopathic & Osteopathic Physicians
Classification Medical Genetics
Specialization Clinical Genetics (M.D.)

Taxonomy Definition

A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Medical Genetics, 2007. http://www.abmg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1962602904 Zohra Shad Medical Genetics 750 8th Ave Ste 200, Fort Worth, TX 76104-2500 2007-07-18
1184651077 Joanne Nguyen Medical Genetics 1300 W Lancaster Ave Ste 204, Fort Worth, TX 76102-3490 2006-06-27
1841281318 Lesley M Drummond-borg Medical Genetics 1300 W Lancaster Ave, Ste 204, Fort Worth, TX 76102-3410 2005-11-02
1265826143 Diana Carrasco Medical Genetics 801 7th Ave, Fort Worth, TX 76104-2733 2015-03-27
1780029504 Peter Jospeh Leahy Medical Genetics 750 8th Ave Ste 200, Fort Worth, TX 76104-2500 2013-05-07
1922354166 Candace Nicole Gamble Medical Genetics 1300 W Lancaster Ave, Ste 204, Fort Worth, TX 76102-3410 2012-07-25
1457648917 Alexandra Garza Flores Medical Genetics 1300 W Lancaster Ave Ste 204, Fort Worth, TX 76102-3490 2011-07-06
1275838088 Tina Grace Barbaro Dieber Medical Genetics 1300 W Lancaster Ave, Ste 204, Fort Worth, TX 76102-3410 2011-01-26

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1639640576 Joseph Leonard Goldstein Medical Genetics 5323 Harry Hines Blvd Frnt, Dallas, TX 75390-7201 2018-12-17
1720335045 Claudia Rocio Soler Alfonso Medical Genetics 6701 Fannin St Ste D1560, Houston, TX 77030-2608 2012-08-06
1104118918 James E Butler Medical Genetics 5931 Crosslake Pkwy, Waco, TX 76712-6986 2011-05-11
1497054993 April Dione Adams Medical Genetics 6651 Main St Ste 1020, Houston, TX 77030-2351 2011-03-23
1558521013 David Felipe Rodriguez Medical Genetics 6431 Fannin Street, Msb 3.144, Houston, TX 77030-2359 2008-06-09
1720298979 Vincent R Macias, Md Pa Clinical Genetics Medical Genetics 725 E Esperanza Ave, Suite A, Mcallen, TX 78501-1402 2007-05-23
1356493472 Verna Lois Morris Rose Medical Genetics 1524 Leander Road, Georgetown, TX 78628 2007-01-17
1093881161 Richard Martin Roberts Medical Genetics 6610 Belvoir Ave, Corpus Christi, TX 78414-3949 2006-11-28
1982795316 Southwest Genetics, P.a. Medical Genetics 7614 Louis Pasteur Dr, Suite 310, San Antonio, TX 78229-4036 2006-09-28
1568574267 Gabriel S Khodr Medical Genetics 7614 Louis Pasteur, #310 Southwest Genetics Pa, San Antonio, TX 78229 2006-08-31
Find all providers with the same taxonomy

Competitor

Search similar providers

City FORT WORTH
Zip Code 76102

Improve Information

Please comment or provide details below to improve the information on MARY K KUKOLICH.

Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

Trending Searches