Provider Demographics
NPI:1801086640
Name:PONNAMMA KUNJAN PILLAI, UNNIKRISHNAN (MD)
Entity type:Individual
Prefix:
First Name:UNNIKRISHNAN
Middle Name:
Last Name:PONNAMMA KUNJAN PILLAI
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 1:800 S TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4529
Mailing Address - Country:US
Mailing Address - Phone:765-281-2000
Mailing Address - Fax:765-281-2062
Practice Address - Street 1:800 S TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4529
Practice Address - Country:US
Practice Address - Phone:765-281-2000
Practice Address - Fax:765-281-2062
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012003999207R00000X, 208M00000X
IN01073178A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201196580Medicaid
IN465610001Medicare PIN