Provider Demographics
NPI:1225036031
Name:KAUL, SURENDRA (MD)
Entity Type:Individual
Prefix:
First Name:SURENDRA
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 1:555 W WACKERLY ST
Mailing Address - Street 2:SUITE 3625
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4710
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:48640-4710
Practice Address - Country:US
Practice Address - Phone:989-835-8625
Practice Address - Fax:989-839-8864
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010398962084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1384422Medicaid
MIB45973Medicare UPIN
MI1384422Medicaid