Healthcare Provider Details

I. General information

NPI: 1801800701
Provider Name (Legal Business Name): BOBBY M KURUVILLA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 TURNPIKE ST SUITE 11
NORTH ANDOVER MA
01845-5924
US

IV. Provider business mailing address

575 TURNPIKE ST SUITE 11
NORTH ANDOVER MA
01845-5924
US

V. Phone/Fax

Practice location:
  • Phone: 978-794-1946
  • Fax: 978-975-3925
Mailing address:
  • Phone: 978-794-1946
  • Fax: 978-975-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006225
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016-005307
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000821
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2381
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0348
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: