1649267972 NPI number — KR BYJU MD

Table of content: KR BYJU MD (NPI 1649267972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649267972 NPI number — KR BYJU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYJU
Provider First Name:
KR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BYJU
Provider Other First Name:
KIZHAKEVILAYIL
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649267972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 UNIVERSITY PKWY
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34243-2893
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-360-2579
Provider Business Mailing Address Fax Number:
941-360-2580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-360-2579
Provider Business Practice Location Address Fax Number:
941-360-2580
Provider Enumeration Date:
10/03/2005

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: 207RG0100X , with the licence number:  ME83308 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ME83308 . This is a "ME NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13743 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2206358 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1339812001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01547 . This is a "UNIVERSAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2744403 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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