Healthcare Provider Details

I. General information

NPI: 1417188723
Provider Name (Legal Business Name): KEVIN NIRAPPUKANDATHIL KURIAKOSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 W FAIRBANKS AVE
WINTER PARK FL
32789-3385
US

IV. Provider business mailing address

7459 RIPPLEPOINTE WAY
WINDERMERE FL
34786-5593
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-2767
  • Fax:
Mailing address:
  • Phone: 917-575-5328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number249785
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberME110394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: