Provider Demographics
NPI:1033198395
Name:KUMAR, MANISH G (MD)
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:G
Last Name:KUMAR
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 1:2880 AAA COURT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3206
Mailing Address - Country:US
Mailing Address - Phone:563-359-7546
Mailing Address - Fax:563-359-8037
Practice Address - Street 1:2880 AAA COURT
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3206
Practice Address - Country:US
Practice Address - Phone:563-359-7546
Practice Address - Fax:563-359-8037
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35482207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0430967Medicaid
IA0430967Medicaid