Healthcare Provider Details

I. General information

NPI: 1003221482
Provider Name (Legal Business Name): KUSHAL NANDAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 W 10TH AVE 760 PRIOR HALL
COLUMBUS OH
43210-1280
US

IV. Provider business mailing address

1044 CONCORD AVE
COLUMBUS OH
43212-2201
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-3551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1003221482
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number83340
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: