Provider Demographics
NPI:1437243656
Name:HALUKURIKE, VISHWANATH N (MD)
Entity Type:Individual
Prefix:
First Name:VISHWANATH
Middle Name:N
Last Name:HALUKURIKE
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 1:1040 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1816
Mailing Address - Country:US
Mailing Address - Phone:434-792-1433
Mailing Address - Fax:434-797-2807
Practice Address - Street 1:429 COMMONWEALTH BLVD E
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2014
Practice Address - Country:US
Practice Address - Phone:276-638-7731
Practice Address - Fax:276-638-7735
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37238207RN0300X
VA0101246233207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64062466Medicaid
VA386923OtherANTHEM
VA1437243656Medicaid
VA4363417OtherCIGNA
VA1437243656Medicaid
KY0680103Medicare ID - Type Unspecified
KY64062466Medicaid
VA021336D35Medicare PIN