Healthcare Provider Details

I. General information

NPI: 1811765001
Provider Name (Legal Business Name): JOSIE KURIAN PAUL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 EDGEWOOD RD SW UNIT 160
CEDAR RAPIDS IA
52404-3391
US

IV. Provider business mailing address

6962 DOUBLETREE RD NE
CEDAR RAPIDS IA
52402-7278
US

V. Phone/Fax

Practice location:
  • Phone: 319-777-0241
  • Fax:
Mailing address:
  • Phone: 720-803-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-10185
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: