Provider Demographics
NPI:1356304539
Name:NAIR, SHYAM KESAVANKUTTY (MD)
Entity Type:Individual
Prefix:
First Name:SHYAM
Middle Name:KESAVANKUTTY
Last Name:NAIR
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:PO BOX 22230
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-2230
Mailing Address - Country:US
Mailing Address - Phone:661-633-1983
Mailing Address - Fax:661-633-1101
Practice Address - Street 1:2007 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4203
Practice Address - Country:US
Practice Address - Phone:661-633-1983
Practice Address - Fax:661-633-1101
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56115207RC0000X, 174400000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A561150Medicare ID - Type Unspecified
CAF78283Medicare UPIN