Provider Demographics
NPI:1073610051
Name:NIGAM, KUMUD (MD)
Entity Type:Individual
Prefix:DR
First Name:KUMUD
Middle Name:
Last Name:NIGAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KUMUD
Other - Middle Name:
Other - Last Name:SRIVASTAVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6957 OLDE CREEK RD
Mailing Address - Street 2:SUITE #3400
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-7416
Mailing Address - Country:US
Mailing Address - Phone:815-397-6276
Mailing Address - Fax:815-397-2266
Practice Address - Street 1:6957 OLDE CREEK RD
Practice Address - Street 2:SUITE #3400
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-7416
Practice Address - Country:US
Practice Address - Phone:815-397-6276
Practice Address - Fax:815-397-2266
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0010100540OtherBCBS
20027734OtherPALMETTO
692770Medicare ID - Type Unspecified
20027734OtherPALMETTO