Provider Demographics
NPI:1346251774
Name:ZACHARIAS, KULANGARA PUNNEN (MD)
Entity Type:Individual
Prefix:
First Name:KULANGARA
Middle Name:PUNNEN
Last Name:ZACHARIAS
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 1:600 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-1753
Mailing Address - Country:US
Mailing Address - Phone:573-592-4100
Mailing Address - Fax:573-592-3023
Practice Address - Street 1:600 E 5TH STREET
Practice Address - Street 2:FULTON STATE HOSPITAL
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251
Practice Address - Country:US
Practice Address - Phone:573-592-4100
Practice Address - Fax:573-592-3023
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5547208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201789500Medicaid
MO201789500Medicaid
MO038050022Medicare PIN