Provider Demographics
NPI:1144244146
Name:KUMAR, VIJAY (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:
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 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:630-789-2571
Practice Address - Street 1:303 E ARMY TRAIL RD
Practice Address - Street 2:SUITE 405
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2169
Practice Address - Country:US
Practice Address - Phone:630-307-0100
Practice Address - Fax:630-307-0111
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061023207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2233084OtherBCBS PROVIDER ID
IL060009558OtherMEDICARE -- RR
ILP00395946OtherRAILROAD MEDICARE
IL060020112OtherMEDICARE -- RR
IL01618378OtherBCBS PROVIDER ID
IL036061023Medicaid
IL060020112OtherMEDICARE -- RR
ILK32652Medicare PIN
IL060009558OtherMEDICARE -- RR
D15426Medicare UPIN
D15426Medicare UPIN