1578554911 NPI number — DR. PARVATHY D KURUP MD

Table of content: DR. PARVATHY D KURUP MD (NPI 1578554911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578554911 NPI number — DR. PARVATHY D KURUP MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURUP
Provider First Name:
PARVATHY
Provider Middle Name:
D
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:
1578554911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 379
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60462-0379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-460-9833
Provider Business Mailing Address Fax Number:
708-460-1117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 N GREENLEAF ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GURNEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60031-3309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-623-2114
Provider Business Practice Location Address Fax Number:
847-623-4628
Provider Enumeration Date:
11/03/2005

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: 2085R0001X , with the licence number:  036058250 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 920007668 . This is a "RR MEDICARE ADVANCED RAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CK9135 . This is a "RR MEDICARE ADV RAD GR#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 04932214 . This is a "BCBSIL ROTATING GAMMA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 01633381 . This is a "BCBIL ADVANCED RAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1902897358 . This is a "ROT GAMMA NPI#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1548251986 . This is a "ADV RAD NPI #" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00042094 . This is a "RR MEDICARE ROT GMA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036058250 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA2626 . This is a "RR MEDICARE ROT GMA GR#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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