Basic Information
| Provider Information | |||||||||
| NPI: | 1487865309 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAUR | ||||||||
| FirstName: | MANJINDER | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5655 HUDSON DR | ||||||||
| Address2: | SUITE 315 | ||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442364451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306505110 | ||||||||
| FaxNumber: | 3306505115 | ||||||||
| Practice Location | |||||||||
| Address1: | 5655 HUDSON DR | ||||||||
| Address2: | SUITE 315 | ||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442364451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306505110 | ||||||||
| FaxNumber: | 3306505115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 02/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 58002047 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 34010053 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 0092544 | 05 | OH | MEDICAID |