Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 35093375 | OH |
N | 207X00000X | Orthopaedic Surgeon | LT 2791 | NH |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036117745 | IL |
NPI | 1003976598 |
---|---|
Provider Name | Sharat Kumar Kusuma |
First Address | Dublin, OH 43016-4259 |
Second Address | Columbus, OH 43215-4600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 18/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2939557 | (05) | OH |
30208278 | (05) | NH |