Provider Demographics
NPI:1124258892
Name:SHARAD KULKARNI M.D. PA
Entity type:Organization
Organization Name:SHARAD KULKARNI M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHWETA
Authorized Official - Middle Name:
Authorized Official - Last Name:KULKARNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-835-7402
Mailing Address - Street 1:2825 INTERSTATE 10 E STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1015
Mailing Address - Country:US
Mailing Address - Phone:409-835-7401
Mailing Address - Fax:409-835-7405
Practice Address - Street 1:2825 INTERSTATE 10 E STE 100
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1015
Practice Address - Country:US
Practice Address - Phone:409-835-7401
Practice Address - Fax:409-835-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128859904Medicaid
TX128859904Medicaid