MEDICARE: SURENDRA KAUL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	4301039896	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225036031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SURENDRA KAUL M.D.

Provider Business Mailing Address
First Line	:	555 W WACKERLY ST
Second Line	:	SUITE 3625
City	:	MIDLAND
State	:	MI
Zip	:	48640-4710
Country	:	US
Telephone Number	:	989-835-8625
Fax Number	:	989-839-8864

Provider Business Practice Location Address
First Line	:	555 W WACKERLY ST
Second Line	:	SUITE 3625
City	:	MIDLAND
State	:	MI
Zip	:	48640-4710
Country	:	US
Telephone Number	:	989-835-8625
Fax Number	:	989-839-8864

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	10/20/2011

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