Provider Demographics
NPI:1841039385
Name:KUGAKUMARAN, GAJAHNAN (MD)
Entity type:Individual
Prefix:MR
First Name:GAJAHNAN
Middle Name:
Last Name:KUGAKUMARAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 N. 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301
Mailing Address - Country:US
Mailing Address - Phone:217-224-9484
Mailing Address - Fax:
Practice Address - Street 1:612 N. 11TH STREET
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301
Practice Address - Country:US
Practice Address - Phone:217-224-9484
Practice Address - Fax:217-228-3030
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program