Provider Demographics
NPI:1568490118
Name:KURICHETY, KIRAN RAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:RAM
Last Name:KURICHETY
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 1:2708 S RIFE MEDICAL LN STE 220
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1456
Mailing Address - Country:US
Mailing Address - Phone:479-338-4400
Mailing Address - Fax:479-338-4445
Practice Address - Street 1:2708 S RIFE MEDICAL LN STE 220
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:479-338-4400
Practice Address - Fax:479-338-4445
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9301207R00000X, 207RC0000X, 207U00000X, 207UN0901X
ARE12282207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00199651Medicare PIN
TX8C6171Medicare PIN
TXI16174Medicare UPIN
TX8C6170Medicare PIN
TX8C2403Medicare PIN