1043522337 NPI number — DR. VIPIN PRABHU KURIACHAN M.D.

Table of content: DR. VIPIN PRABHU KURIACHAN M.D. (NPI 1043522337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043522337 NPI number — DR. VIPIN PRABHU KURIACHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURIACHAN
Provider First Name:
VIPIN
Provider Middle Name:
PRABHU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1043522337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 N MACARTHUR BLVD
Provider Second Line Business Mailing Address:
STE 150
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75061-2219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-253-2560
Provider Business Mailing Address Fax Number:
972-253-4218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6750 N MACARTHUR BLVD
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75039-2875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-823-6430
Provider Business Practice Location Address Fax Number:
972-823-6431
Provider Enumeration Date:
07/02/2010

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: Q0489 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3374704 01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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