Provider Demographics
NPI:1629051875
Name:KIRUBAKARAN, AZARIAH (MD)
Entity Type:Individual
Prefix:
First Name:AZARIAH
Middle Name:
Last Name:KIRUBAKARAN
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 1:110 N 29TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4424
Mailing Address - Country:US
Mailing Address - Phone:402-844-8284
Mailing Address - Fax:402-844-8175
Practice Address - Street 1:110 N 29TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4424
Practice Address - Country:US
Practice Address - Phone:402-844-8284
Practice Address - Fax:402-844-8175
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19355207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology