Provider Demographics
NPI:1992777866
Name:KAUL, SANJAY (MD)
Entity type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:
Last Name:KAUL
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:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210-0369
Mailing Address - Country:US
Mailing Address - Phone:270-597-2155
Mailing Address - Fax:270-597-3811
Practice Address - Street 1:104 MOHAWK ST
Practice Address - Street 2:104 MOHAWK STREET
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210-9006
Practice Address - Country:US
Practice Address - Phone:270-597-2155
Practice Address - Fax:270-597-3811
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36833207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65945792Medicaid
KY64030224Medicaid
KY64030224Medicaid
KYH41079Medicare UPIN
KY00086Medicare ID - Type UnspecifiedGROUP