Basic Information
Provider Information | |||||||||
NPI: | 1699090415 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PALANIANDY K KOGULAN MD PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3785 BAY RD | ||||||||
Address2: |   | ||||||||
City: | SAGINAW | ||||||||
State: | MI | ||||||||
PostalCode: | 48603 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9897912455 | ||||||||
FaxNumber: | 9897911392 | ||||||||
Practice Location | |||||||||
Address1: | 3150 HALLMARK CT | ||||||||
Address2: |   | ||||||||
City: | SAGINAW | ||||||||
State: | MI | ||||||||
PostalCode: | 486032173 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9897934420 | ||||||||
FaxNumber: | 9897917068 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/05/2010 | ||||||||
LastUpdateDate: | 06/04/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KOGULAN | ||||||||
AuthorizedOfficialFirstName: | PALANIANDY | ||||||||
AuthorizedOfficialMiddleName: | K | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 9897917085 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 4301082867 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
ID | Type | State | Issuer | Description | 1255436309 | 05 | MI |   | MEDICAID | P00838756 | 01 | MI | RAILROAD MEDICARE | OTHER | 01028605 | 01 | MI | HEALTHPLUS OF MICHIGAN | OTHER | 0730504 | 01 | MI | BCBSM | OTHER | MI2987001 | 01 | MI | MEDICARE PTAN | OTHER |