Provider Demographics
NPI:1225309222
Name:KULKARNI, SUPRIYA PRADEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:SUPRIYA
Middle Name:PRADEEP
Last Name:KULKARNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11322 FRANKLIN PLZ
Mailing Address - Street 2:APT 915
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4922
Mailing Address - Country:US
Mailing Address - Phone:646-915-6775
Mailing Address - Fax:
Practice Address - Street 1:11322 FRANKLIN PLZ
Practice Address - Street 2:APT 915
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4922
Practice Address - Country:US
Practice Address - Phone:646-915-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD160833207R00000X
CT55180207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism