MEDICARE: SIVA P KURUP MD INC

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	2084P0805X	Geriatric Psychiatry Physician	35036209	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568737526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIVA P KURUP MD INC

Provider Business Mailing Address
First Line	:	1704 NORTH RD SE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-2958
Country	:	US
Telephone Number	:	330-856-3633
Fax Number	:

Provider Business Practice Location Address
First Line	:	1704 NORTH RD SE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-2958
Country	:	US
Telephone Number	:	330-856-3633
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	SIVA P KURUP
Credential	:	M.D.
Telephone Number	:	330-856-3633

Provider Enumeration Date	:	03/09/2012
Last Update Date	:	03/09/2012

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