Provider Demographics
NPI:1427082486
Name:KURIAN, KIZHAKE C (MD)
Entity type:Individual
Prefix:
First Name:KIZHAKE
Middle Name:C
Last Name:KURIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MEMORIAL MEDICAL PARKWAY
Mailing Address - Street 2:3808
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164
Mailing Address - Country:US
Mailing Address - Phone:386-586-1930
Mailing Address - Fax:386-586-1931
Practice Address - Street 1:61 MEMORIAL MEDICAL PARKWAY
Practice Address - Street 2:3808
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164
Practice Address - Country:US
Practice Address - Phone:386-586-1930
Practice Address - Fax:386-586-1931
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77792207RC0000X
FLME 88287207RC0000X
OH80336207RC0000X
TXM8775207RC0000X
GA064130207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K6574Medicare PIN