Provider Demographics
NPI:1386848133
Name:JATINDER N KAUSHAL MD INC
Entity Type:Organization
Organization Name:JATINDER N KAUSHAL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGFELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-626-0056
Mailing Address - Street 1:315 W LINCOLN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3851
Mailing Address - Country:US
Mailing Address - Phone:765-626-0056
Mailing Address - Fax:765-864-9220
Practice Address - Street 1:315 W LINCOLN RD
Practice Address - Street 2:SUITE A
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3851
Practice Address - Country:US
Practice Address - Phone:765-626-0056
Practice Address - Fax:765-864-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037318207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100137720Medicaid
IN100012718OtherRAILROAD MEDICARE
IN100012718OtherRAILROAD MEDICARE
IN100137720Medicaid