Provider Demographics
NPI:1376772541
Name:NAGARAJAN, KIRAN KOUSHIK (MD)
Entity type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:KOUSHIK
Last Name:NAGARAJAN
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 1:3522 GOLDEN VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-5805
Mailing Address - Country:US
Mailing Address - Phone:919-961-0382
Mailing Address - Fax:
Practice Address - Street 1:JOHNSON BUILDING SUITE 227A 847 MONROE AVENUE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-2140
Practice Address - Country:US
Practice Address - Phone:901-448-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN71185207Q00000X, 208M00000X
SC61267207Q00000X
NC2020-04699208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FN0873477OtherDEA