Provider Demographics
NPI:1053555177
Name:KURIAN, SANDHYA TIWADE (MD)
Entity type:Individual
Prefix:DR
First Name:SANDHYA
Middle Name:TIWADE
Last Name:KURIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 MANCHESTER RD STE E
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1307
Mailing Address - Country:US
Mailing Address - Phone:314-428-9541
Mailing Address - Fax:
Practice Address - Street 1:10700 MANCHESTER RD STE E
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-1307
Practice Address - Country:US
Practice Address - Phone:314-428-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2017008412207Q00000X
IL036-130438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207219OtherPTAN