Mary K Kukolich, MD

Primary specialty

Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X

License

E5817 Issued in TX

Practice address

750 8TH Ave Ste 200
Fort Worth, TX 76104-2500

Phone

(682) 885-2170

Fax

(817) 335-8277

NPI assigned

Aug 11, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mkukolich14945@cookchildrens.direct-ci.com
• Direct secure messaging: mary.kukolich@direct.myteamcare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cook Children'S Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1750369203

  Clinical Genetics (M.D.)

  Medicare reassignment NPD
• Cook Children'S Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1083472062
  NPD
• Obstetrix Medical Group of Texas Billing, Inc.

  • Maternal & Fetal Medicine Physician
  • Richardson, TX
  • NPI 1568486264
  NPD (past)
• Pediatrix Medical Group of Texas Billing, Inc.

  • Neonatal-Perinatal Medicine Physician
  • Houston, TX
  • NPI 1649377359

  Pediatrics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621209600000",
    "number": "1912918111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-1855",
            "fax_number": "682-885-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 8TH AVE STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042500",
            "telephone_number": "682-885-2170",
            "fax_number": "817-335-8277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUKOLICH",
        "first_name": "MARY",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "E5817",
            "primary": false
        },
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "TX",
            "license": "E5817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkukolich14945@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "1300 W Lancaster Ave",
            "address_2": "STE 204",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761023410",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkukolich14945@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "750 8th Ave Ste 200",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761042500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristi Montgomery Kuenstler, MD
• Gina Kuenzi, RN, MSN
• Alexandra Kuhn, PA-C
• Kristin Diane Kuhn, CRNA
• Hyndavi Kukkadapu
• Cynthia M Kulik, DO
• Nitin Krishnaji Kulkarni, MD
• Ameet Kumar, M.D
• Anjali Kumar, DO
• Neetal Kumar, MD

• Clinical Genetics (M.D.) Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Clinical Genetics (M.D.) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.