Provider Demographics
NPI:1679669576
Name:KUGELMANN, LAURETTE DEKAT (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:LAURETTE
Middle Name:DEKAT
Last Name:KUGELMANN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:LAURETTE
Other - Middle Name:KATHRYN
Other - Last Name:DEKAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:6138 NORTHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2944
Mailing Address - Country:US
Mailing Address - Phone:214-987-2348
Mailing Address - Fax:972-721-5124
Practice Address - Street 1:1845 E NORTHGATE DR
Practice Address - Street 2:UNIVERSITY OF DALLAS STUDENT HEALTH CENTER
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4736
Practice Address - Country:US
Practice Address - Phone:972-721-5322
Practice Address - Fax:972-721-5124
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4969208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB70690Medicare UPIN