Provider Demographics
NPI:1447435748
Name:THOMMAN KURUVILLA LLC
Entity type:Organization
Organization Name:THOMMAN KURUVILLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KURUVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:646-369-4507
Mailing Address - Street 1:PO BOX 98898
Mailing Address - Street 2:DRAWER #1014
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8898
Mailing Address - Country:US
Mailing Address - Phone:646-369-4507
Mailing Address - Fax:
Practice Address - Street 1:3017 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 90
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1941
Practice Address - Country:US
Practice Address - Phone:702-878-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0606213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty