Provider Demographics
NPI:1720014509
Name:KUSNOOR, VIJAY S (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:S
Last Name:KUSNOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2929 CALDER
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1841
Mailing Address - Country:US
Mailing Address - Phone:409-833-9797
Mailing Address - Fax:409-654-6886
Practice Address - Street 1:3570 COLLEGE
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4679
Practice Address - Country:US
Practice Address - Phone:409-839-3118
Practice Address - Fax:409-654-6922
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2018-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF5263207RC0000X, 208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BZ707OtherBCBS TEXAS
TX137824212Medicaid
TX8L13684Medicare PIN
TXP00728911Medicare PIN