Provider Demographics
NPI:1184974958
Name:KURIAKOSE, BIJU MUCHAL (CRNA/APRN)
Entity type:Individual
Prefix:MR
First Name:BIJU
Middle Name:MUCHAL
Last Name:KURIAKOSE
Suffix:
Gender:M
Credentials:CRNA/APRN
Other - Prefix:
Other - First Name:BIJU
Other - Middle Name:
Other - Last Name:KURIAKOSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:6720 BERTNER AVE STE 8490
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2604
Mailing Address - Country:US
Mailing Address - Phone:832-355-2666
Mailing Address - Fax:
Practice Address - Street 1:6720 BERTNER AVE STE 8490
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2604
Practice Address - Country:US
Practice Address - Phone:832-355-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5198367500000X
PARN585573367500000X
TXAP122904367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA267250Medicare PIN