Provider Demographics
NPI:1801800701
Name:KURUVILLA, BOBBY M (DPM)
Entity type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:M
Last Name:KURUVILLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:575 TURNPIKE ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5924
Mailing Address - Country:US
Mailing Address - Phone:978-794-1946
Mailing Address - Fax:978-975-3925
Practice Address - Street 1:575 TURNPIKE ST
Practice Address - Street 2:SUITE 11
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5924
Practice Address - Country:US
Practice Address - Phone:978-794-1946
Practice Address - Fax:978-975-3925
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006225213ES0103X
IL016-005307213ES0103X
CT000821213ES0103X
MA2381213ES0103X
NH0348213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT480001025Medicare PIN
MA002622101Medicare PIN