Provider Demographics
NPI:1073772224
Name:KURIAKOSE, AJITH (MD)
Entity Type:Individual
Prefix:
First Name:AJITH
Middle Name:
Last Name:KURIAKOSE
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 1:710 S 8TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4680
Mailing Address - Country:US
Mailing Address - Phone:409-212-9240
Mailing Address - Fax:409-212-9239
Practice Address - Street 1:710 S 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4680
Practice Address - Country:US
Practice Address - Phone:409-212-9240
Practice Address - Fax:409-212-9239
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1718207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH57317Medicare UPIN
TXTXB116858Medicare PIN
MIB06000053Medicare PIN