Healthcare Provider Details

I. General information

NPI: 1174688360
Provider Name (Legal Business Name): THOMAS KANJAPALILL KURIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST SUITE 400
AUSTIN TX
78705-1000
US

IV. Provider business mailing address

1301 W 38TH ST SUITE 400
AUSTIN TX
78705-1000
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-3440
  • Fax: 512-406-6513
Mailing address:
  • Phone: 512-324-3440
  • Fax: 512-406-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2006034487
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2006034487
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR0440
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: