Provider Demographics
NPI:1063491066
Name:KUMAR, BIRENDRA S (MD)
Entity Type:Individual
Prefix:
First Name:BIRENDRA
Middle Name:S
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 1:110105 PIONEER W TRL 302
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2680
Mailing Address - Country:US
Mailing Address - Phone:952-361-5800
Mailing Address - Fax:952-361-5858
Practice Address - Street 1:1230 E MAIN ST
Practice Address - Street 2:MANKATO CLINIC AT MAIN STREET
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5066
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39113207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN335L2KUOtherBCBS
P00211303OtherRR MEDICARE
MN256514500Medicaid
MN3600541OtherMEDICA
MNNA2951011969OtherPREFERRED ONE
IA0593046Medicaid
MN115710OtherUCARE
MN773738OtherAMERICAS PPO
MNHP21623OtherHEALTH PARTNERS
41084933956001C219OtherCHAMPUS
MN335L2KUOtherBCBS
MNNA2951011969OtherPREFERRED ONE