=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992846927
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRAMOD S KULKARNI MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2007
-----------------------------------------------------
Last Update Date | 10/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11632 BUTTERFIELD ST
-----------------------------------------------------
City | LOMA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92354-3956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-799-9115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11632 BUTTERFIELD ST
-----------------------------------------------------
City | LOMA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92354-3956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-799-9115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PRAMOD S KULKARNI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 909-799-9115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | A40807
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------