1548260904 NPI number — DR. VAISHALI B KUTE MD

Table of content: DR. VAISHALI B KUTE MD (NPI 1548260904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548260904 NPI number — DR. VAISHALI B KUTE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUTE
Provider First Name:
VAISHALI
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548260904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4807 BLYTH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNWOODY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30338-5021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-667-6967
Provider Business Mailing Address Fax Number:
770-667-6908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3155 N POINT PKWY
Provider Second Line Business Practice Location Address:
BLDG D STE 200
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30005-5481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-667-6967
Provider Business Practice Location Address Fax Number:
866-578-7440
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  045526 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 045526 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000825041D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com