Healthcare Provider Details

I. General information

NPI: 1275684482
Provider Name (Legal Business Name): PULIN BEHARI KOUL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR FL 3 UFJP PEDIATRIC CRITICAL CARE
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

PO BOX 44008 UFJP PROVIDER ENROLLMENT
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-8758
  • Fax:
Mailing address:
  • Phone: 904-244-3660
  • Fax: 904-244-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME95129
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: