Healthcare Provider Details

I. General information

NPI: 1790725158
Provider Name (Legal Business Name): MOHAN GANESH KULKARNI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MICHIGAN AVE SUITE 103
JACKSON MI
49201-2457
US

IV. Provider business mailing address

900 E MICHIGAN AVE SUITE 103
JACKSON MI
49201-2457
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-6007
  • Fax: 517-788-6438
Mailing address:
  • Phone: 517-788-6007
  • Fax: 517-788-6438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number4301066998
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301066998
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: