Provider Demographics
NPI:1023202637
Name:SURENDRA KAUL, M.D.-P.C.
Entity Type:Organization
Organization Name:SURENDRA KAUL, M.D.-P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-835-8625
Mailing Address - Street 1:555 W. WACKERLY STREET
Mailing Address - Street 2:SUITE 3625
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4715
Mailing Address - Country:US
Mailing Address - Phone:989-835-8625
Mailing Address - Fax:989-839-8864
Practice Address - Street 1:555 W WACKERLY ST
Practice Address - Street 2:SUITE 3625
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4722
Practice Address - Country:US
Practice Address - Phone:989-835-8625
Practice Address - Fax:989-839-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010398962084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI138442210Medicaid
MIB45973Medicare UPIN
MI138442210Medicaid