Provider Demographics
NPI:1184602393
Name:KURUNTHOTTICAL, RAJU Z (DO)
Entity type:Individual
Prefix:DR
First Name:RAJU
Middle Name:Z
Last Name:KURUNTHOTTICAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:RAJU
Other - Middle Name:Z
Other - Last Name:PANCHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:301 SETON PKWY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-8002
Mailing Address - Country:US
Mailing Address - Phone:512-324-4813
Mailing Address - Fax:512-324-4813
Practice Address - Street 1:301 SETON PKWY
Practice Address - Street 2:SUITE 401
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8002
Practice Address - Country:US
Practice Address - Phone:512-324-4813
Practice Address - Fax:512-324-4813
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8276207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041893102Medicaid
TX041893104Medicaid
TX8BP450OtherBCBS INDIVIDUAL #
TX041893102Medicaid
TX041893104Medicaid