Provider Demographics
NPI:1043286909
Name:KULKARNI, AMI S (DO)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:S
Last Name:KULKARNI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8233 GLENCARIN BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5784
Practice Address - Country:US
Practice Address - Phone:260-425-5470
Practice Address - Fax:260-425-5475
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002687A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2453929Medicaid
INP00783783OtherRAILROAD MEDICARE
IN000000314231OtherANTHEM
IN200462090Medicaid
IN260690NNMedicare PIN
IN200462090Medicaid
IN058490RRMedicare ID - Type Unspecified