Provider Demographics
NPI:1366706293
Name:OZHATHIL, DEEPAK KURIAN (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:KURIAN
Last Name:OZHATHIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BARRACUDA AVE
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-3221
Mailing Address - Country:US
Mailing Address - Phone:508-654-8246
Mailing Address - Fax:
Practice Address - Street 1:110 BARRACUDA AVE
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-3221
Practice Address - Country:US
Practice Address - Phone:508-654-8246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS2014-0553208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery