Provider Demographics
NPI:1255540548
Name:KURIAKOSE, EMIL TOM (MD)
Entity type:Individual
Prefix:
First Name:EMIL
Middle Name:TOM
Last Name:KURIAKOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EMIL
Other - Middle Name:TOM
Other - Last Name:KURIAKOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7603 263RD ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1142
Mailing Address - Country:US
Mailing Address - Phone:469-713-4652
Mailing Address - Fax:
Practice Address - Street 1:5201 HARRY HINES BLVD
Practice Address - Street 2:HOUSE STAFF & GME
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7708
Practice Address - Country:US
Practice Address - Phone:214-590-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN0907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN0907OtherTEXAS MEDICAL BOARD LISENCE
BP1-0026147OtherINSTITUTIONAL PERMIT