Provider Demographics
NPI:1104016617
Name:KUMAR, SURESH NARAYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:NARAYAN
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 1:939 E EMERALD AVE STE 610
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4569
Mailing Address - Country:US
Mailing Address - Phone:865-637-8635
Mailing Address - Fax:865-637-9882
Practice Address - Street 1:939 E EMERALD AVE STE 610
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4569
Practice Address - Country:US
Practice Address - Phone:865-637-8635
Practice Address - Fax:865-637-9882
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203941390200000X
TN48630207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN48630OtherLICENSE