Provider Demographics
NPI:1053443044
Name:KESAVAN, ARUNKUMAR (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ARUNKUMAR
Middle Name:
Last Name:KESAVAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2362 PINE RUN CT SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7951
Mailing Address - Country:US
Mailing Address - Phone:616-785-4154
Mailing Address - Fax:616-855-1945
Practice Address - Street 1:2362 PINE RUN CT SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7951
Practice Address - Country:US
Practice Address - Phone:616-785-4154
Practice Address - Fax:616-855-1945
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009157225100000X
IN05008953A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOD10356OtherBCBSM/BCN