Provider Demographics
NPI:1639345200
Name:S.M. KAURA M.D., PLLC
Entity Type:Organization
Organization Name:S.M. KAURA M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURINDER
Authorized Official - Middle Name:MOHAN
Authorized Official - Last Name:KAURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-382-3400
Mailing Address - Street 1:6801 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2007
Mailing Address - Country:US
Mailing Address - Phone:313-382-3400
Mailing Address - Fax:313-382-0150
Practice Address - Street 1:6801 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2007
Practice Address - Country:US
Practice Address - Phone:313-382-3400
Practice Address - Fax:313-382-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISK036001171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104241405Medicaid
MIB43517Medicare UPIN
MI0N18830Medicare PIN