Healthcare Provider Details

I. General information

NPI: 1992777866
Provider Name (Legal Business Name): SANJAY KAUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MOHAWK ST 104 MOHAWK STREET
BROWNSVILLE KY
42210-9006
US

IV. Provider business mailing address

PO BOX 369
BROWNSVILLE KY
42210-0369
US

V. Phone/Fax

Practice location:
  • Phone: 270-597-2155
  • Fax: 270-597-3811
Mailing address:
  • Phone: 270-597-2155
  • Fax: 270-597-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36833
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: