Healthcare Provider Details

I. General information

NPI: 1922241264
Provider Name (Legal Business Name): ALEXANDER SHANKUI KUO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST GRAY-BIGELOW 444, DEPT ANESTHESIA
BOSTON MA
02114-2621
US

IV. Provider business mailing address

475 BEACON ST APT 1F
BOSTON MA
02115-1331
US

V. Phone/Fax

Practice location:
  • Phone: 248-535-4116
  • Fax:
Mailing address:
  • Phone: 248-535-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number249929
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number249929
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: