MEDICARE: DR. MUTHUMEENA KANNAPPAN MD, MPH

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	207Q00000X	Family Medicine Physician	0101285177	VA
2	208M00000X	Hospitalist Physician	01085612A	IN
3	207Q00000X	Family Medicine Physician	01085612A	IN

General Provider Information

NPI Number	:	1750887717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUTHUMEENA KANNAPPAN MD, MPH

Provider Business Mailing Address
First Line	:	158 E 38TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2810
Country	:	US
Telephone Number	:	646-499-0328
Fax Number	:

Provider Business Practice Location Address
First Line	:	158 E 38TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2810
Country	:	US
Telephone Number	:	646-499-0328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	03/17/2026

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