Provider Demographics
NPI:1558318428
Name:KULASINGHAM, SHIVAN (MD)
Entity Type:Individual
Prefix:
First Name:SHIVAN
Middle Name:
Last Name:KULASINGHAM
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 1:1027 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3409
Mailing Address - Country:US
Mailing Address - Phone:218-847-5611
Mailing Address - Fax:218-847-0881
Practice Address - Street 1:1027 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3409
Practice Address - Country:US
Practice Address - Phone:218-847-5611
Practice Address - Fax:218-847-0881
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0403132OtherMEDICA #
MNDA9031026977OtherPREFERRED ONE #
MN20796OtherNDBS #
MN619745100Medicaid
MN1517801OtherAMERICA'S PPO/ARAZ #
MNHP38423OtherHEALTHPARTNERS #
MN11620Medicaid
MNMN10224701OtherLHS/BANNERHEALTH #
MN142026OtherUCARE #
MN43G20KUOtherMNBS #
MN619745100Medicaid
MN110007710Medicare ID - Type UnspecifiedMN MEDICARE #
MN11620Medicaid