Healthcare Provider Details

I. General information

NPI: 1952532988
Provider Name (Legal Business Name): SUNIL KURUP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2009
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 ROUTH ST
DALLAS TX
75201-1414
US

IV. Provider business mailing address

2821 ROUTH ST
DALLAS TX
75201-1414
US

V. Phone/Fax

Practice location:
  • Phone: 214-296-0269
  • Fax: 469-212-1188
Mailing address:
  • Phone: 214-296-0269
  • Fax: 469-212-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42903
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101246205
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberQ6440
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: