Basic Information
| Provider Information | |||||||||
| NPI: | 1861674855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KATSELNIK | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4118 POND HILL RD BLDG 3 | ||||||||
| Address2: | |||||||||
| City: | SHAVANO PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782311281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104943739 | ||||||||
| FaxNumber: | 2104902164 | ||||||||
| Practice Location | |||||||||
| Address1: | 4118 POND HILL RD BLDG 3 | ||||||||
| Address2: | |||||||||
| City: | SHAVANO PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782311281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104943739 | ||||||||
| FaxNumber: | 2104902164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2007 | ||||||||
| LastUpdateDate: | 03/21/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | N1705 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207R00000X | N1705 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.