Provider Demographics
NPI:1659328995
Name:THUNDIYIL, JOSEF GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:JOSEF
Middle Name:GEORGE
Last Name:THUNDIYIL
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 1:1720 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2912
Mailing Address - Country:US
Mailing Address - Phone:415-336-8324
Mailing Address - Fax:
Practice Address - Street 1:1720 COOK AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2912
Practice Address - Country:US
Practice Address - Phone:321-841-2605
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78330207P00000X
FLME81687207PT0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A783300Medicaid
CA00A783300Medicaid