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NPI Code Detail

MEDICARE: DR. THOMMAN M KURUVILLA DPM

MEDICARE: DR. THOMMAN M KURUVILLA DPM
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
1213ES0103XFoot & Ankle Surgery PodiatristN006123-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10606OTHERNVSTATE LICENSE

General Provider Information

NPI Number : 1578628095
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMMAN M KURUVILLA DPM
Provider Business Mailing Address
First Line : PO BOX 50605
Second Line :
City : HENDERSON
State : NV
Zip : 89016-0605
Country : US
Telephone Number : 702-740-5327
Fax Number :
Provider Business Practice Location Address
First Line : 7195 ADVANCED WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-3691
Country : US
Telephone Number : 702-740-5327
Fax Number : 702-740-5328
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2006
Last Update Date : 01/03/2022

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