Provider Demographics
NPI:1477591824
Name:KURIAN, NEESHA DEVARAJ (MD)
Entity Type:Individual
Prefix:
First Name:NEESHA
Middle Name:DEVARAJ
Last Name:KURIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4590 S LINDBERGH BLVD
Mailing Address - Street 2:C/O MARY CAPPEL
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1832
Mailing Address - Country:US
Mailing Address - Phone:314-849-7669
Mailing Address - Fax:314-849-7670
Practice Address - Street 1:4000 JENNINGS STATION RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-3323
Practice Address - Country:US
Practice Address - Phone:314-679-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177252701Medicaid
TX8D9669Medicare ID - Type Unspecified
TX177252701Medicaid