Provider Demographics
NPI:1295826493
Name:JOHN, KURUVILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:KURUVILLA
Middle Name:
Last Name:JOHN
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 1:9500 EUCLID AVE # S90
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-5563
Mailing Address - Fax:216-444-9463
Practice Address - Street 1:9500 EUCLID AVE # S90
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1223
Practice Address - Country:US
Practice Address - Phone:216-444-5563
Practice Address - Fax:216-444-9463
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV160972084N0400X
OH35-05-09912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0089936000Medicaid
WV0089936000Medicaid
E68854Medicare UPIN