1306948930 NPI number — SRIPATT KULKAMTHORN M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306948930 NPI number — SRIPATT KULKAMTHORN M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KULKAMTHORN

Provider First Name:

SRIPATT

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1306948930

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/07/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 1239

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

TROY

Provider Business Mailing Address State Name:

MI

Provider Business Mailing Address Postal Code:

48099-1239

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

248-824-6600

Provider Business Mailing Address Fax Number:

248-324-1477

Provider First Line Business Practice Location Address:

8710 MANCHESTER RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SAINT LOUIS

Provider Business Practice Location Address State Name:

MO

Provider Business Practice Location Address Postal Code:

63144-2724

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

314-961-3570

Provider Business Practice Location Address Fax Number:

314-961-6450

Provider Enumeration Date:

09/03/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  35018 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 208600000X , with the licence number: 35018 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 0004000577 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 327602073KUL . This is a "MERCY HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 3542 . This is a "HEALTHCARE USA PROVIDER #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 2365237 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 115186 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 201098019 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
• Identifier: 01003230 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 431280201 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: A09758 . This is a "CMR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 32901 . This is a "MISSOURI BC/BS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 45992 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".