Basic Information
| Provider Information | |||||||||
| NPI: | 1689916975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRIPATHI | ||||||||
| FirstName: | KUSH | ||||||||
| MiddleName: | HARSHAVARDHAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4515 WILES RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | COCONUT CREEK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330733414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549431133 | ||||||||
| FaxNumber: | 9545327729 | ||||||||
| Practice Location | |||||||||
| Address1: | 4515 WILES RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | COCONUT CREEK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549431133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2013 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 125064824 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 136066 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207LP2900X | 136066 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.