Provider Demographics
NPI:1376069955
Name:KUPPUSAMY, MADHANKUMAR (MD, FRCS (C-TH))
Entity Type:Individual
Prefix:DR
First Name:MADHANKUMAR
Middle Name:
Last Name:KUPPUSAMY
Suffix:
Gender:M
Credentials:MD, FRCS (C-TH)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE FL 6
Mailing Address - Street 2:MS: C6-GS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-341-0060
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE FL 6
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-341-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATR60751395208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WATR60751395OtherWA LICENSE