MEDICARE: THOMMAN KURUVILLA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	0606	NV

General Provider Information

NPI Number	:	1447435748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMMAN KURUVILLA LLC

Provider Business Mailing Address
First Line	:	PO BOX 98898
Second Line	:	DRAWER #1014
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8898
Country	:	US
Telephone Number	:	646-369-4507
Fax Number	:

Provider Business Practice Location Address
First Line	:	3017 W CHARLESTON BLVD
Second Line	:	SUITE 90
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1941
Country	:	US
Telephone Number	:	702-878-5252
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMMAN KURUVILLA
Credential	:	DPM
Telephone Number	:	646-369-4507

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	01/04/2008

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