Provider Demographics
NPI:1700503091
Name:UPADHYAY, KAUSHAL AMRUTLAL (MBBS MD MS)
Entity type:Individual
Prefix:
First Name:KAUSHAL
Middle Name:AMRUTLAL
Last Name:UPADHYAY
Suffix:
Gender:M
Credentials:MBBS MD MS
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Other - Last Name:
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Mailing Address - Street 1:705 RILEY HOSPITAL DR RM W6130A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR RM W6130A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:253-223-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11023333A390200000X
FL36474207XP3100X
ALL6145VP207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery