Provider Demographics
NPI:1760489173
Name:KUMARAN, THURAI Y (MD)
Entity Type:Individual
Prefix:
First Name:THURAI
Middle Name:Y
Last Name:KUMARAN
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:PO BOX 1369
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-8169
Mailing Address - Country:US
Mailing Address - Phone:419-352-2105
Mailing Address - Fax:419-352-2695
Practice Address - Street 1:960 W WOOSTER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2644
Practice Address - Country:US
Practice Address - Phone:419-352-2105
Practice Address - Fax:419-352-2695
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2053745Medicaid
OH0843117Medicare PIN