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NPI Code Detail

MEDICARE: MR. GAJAHNAN KUGAKUMARAN M.D.

MEDICARE: MR. GAJAHNAN KUGAKUMARAN 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
1207Q00000XFamily Medicine Physician125.084400IL

General Provider Information

NPI Number : 1841039385
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GAJAHNAN KUGAKUMARAN M.D.
Provider Business Mailing Address
First Line : 612 N 11TH ST
Second Line :
City : QUINCY
State : IL
Zip : 62301-2662
Country : US
Telephone Number : 217-224-9484
Fax Number : 217-224-7950
Provider Business Practice Location Address
First Line : 612 N 11TH ST
Second Line :
City : QUINCY
State : IL
Zip : 62301-2662
Country : US
Telephone Number : 217-224-9484
Fax Number : 217-224-7950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2024
Last Update Date : 01/12/2026

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