1710210521 NPI number — DR. PAUL N KURIA DNP

Table of content: DR. PAUL N KURIA DNP (NPI 1710210521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710210521 NPI number — DR. PAUL N KURIA DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURIA
Provider First Name:
PAUL
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP
Provider Gender Code:
M

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:
1710210521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55714 BLACK PHEASANT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSCEOLA
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46561-8515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-674-8527
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5215 HOLY CROSS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISHAWAKA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46545-1469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-335-1127
Provider Business Practice Location Address Fax Number:
574-335-2262
Provider Enumeration Date:
09/10/2009

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: 363LA2200X , with the licence number:  28163746A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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