Provider Demographics
NPI:1417188723
Name:KURIAKOSE, KEVIN NIRAPPUKANDATHIL (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:NIRAPPUKANDATHIL
Last Name:KURIAKOSE
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 1:7459 RIPPLEPOINTE WAY
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5593
Mailing Address - Country:US
Mailing Address - Phone:917-575-5328
Mailing Address - Fax:
Practice Address - Street 1:2660 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3385
Practice Address - Country:US
Practice Address - Phone:407-898-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2497852080P0214X
FLME1103942080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1417188723Medicaid