Provider Demographics
NPI:1487865309
Name:KAUR, MANJINDER (DO)
Entity Type:Individual
Prefix:
First Name:MANJINDER
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SEASONS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44224
Mailing Address - Country:US
Mailing Address - Phone:330-650-5110
Mailing Address - Fax:330-650-5115
Practice Address - Street 1:231 SEASONS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44224
Practice Address - Country:US
Practice Address - Phone:330-650-5110
Practice Address - Fax:330-650-5115
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58002047207R00000X
OH34010053207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092544Medicaid