Basic Information
| Provider Information | |||||||||
| NPI: | 1184690745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUTHU | ||||||||
| FirstName: | KANAGASABAI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2753 SHAMROCK DR | ||||||||
| Address2: | |||||||||
| City: | ALLISON PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151013146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125785323 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4800 FRIENDSHIP AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152241722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125785323 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 11/27/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD420467 | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0019152950004 | 05 | PA | MEDICAID | 3003792000 | 05 | WV | MEDICAID | 2377995 | 05 | OH | MEDICAID |