Provider Demographics
NPI:1366438566
Name:NARENDRAN, KUMARAPILLAI
Entity type:Individual
Prefix:
First Name:KUMARAPILLAI
Middle Name:
Last Name:NARENDRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1312
Mailing Address - Country:US
Mailing Address - Phone:806-795-5561
Mailing Address - Fax:806-793-9817
Practice Address - Street 1:3712 22ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1312
Practice Address - Country:US
Practice Address - Phone:806-795-5561
Practice Address - Fax:806-793-9817
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3564207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMY8385Medicaid
TX148066702Medicaid
TX0067BAOtherBLUE CROSS BLUE SHIELD
TX751735633OtherTAX ID NUMBER
TX148066702Medicaid
TXC19779Medicare UPIN