Provider Demographics
NPI:1013991843
Name:KULASEKARAN, THIRUVENGADAM (MD)
Entity Type:Individual
Prefix:
First Name:THIRUVENGADAM
Middle Name:
Last Name:KULASEKARAN
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 1:300 LOCUST ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1821
Mailing Address - Country:US
Mailing Address - Phone:330-253-2113
Mailing Address - Fax:330-253-2362
Practice Address - Street 1:300 LOCUST ST
Practice Address - Street 2:SUITE 150
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1821
Practice Address - Country:US
Practice Address - Phone:330-253-2113
Practice Address - Fax:330-253-2362
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046455K2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0468533Medicaid
OHKU0520672Medicare PIN
A80466Medicare UPIN