Healthcare Provider Details

I. General information

NPI: 1740206234
Provider Name (Legal Business Name): KOMPANCARIEL ELZY KURUVILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST MEDICAL CENTER DR
ANN ARBOR MI
48109-0048
US

IV. Provider business mailing address

3621 S STATE ST 700 KMS PLACE ATTN ELLEN KAYFES
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-4280
  • Fax:
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301087027
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: