Provider Demographics
NPI:1215004726
Name:KUMAR, SATHEESH BALAKRISHNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SATHEESH
Middle Name:BALAKRISHNAN
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 1:1201 E SCHUSTER AVE STE 3B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4646
Mailing Address - Country:US
Mailing Address - Phone:915-533-5911
Mailing Address - Fax:
Practice Address - Street 1:1201 E SCHUSTER AVE STE 3B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4646
Practice Address - Country:US
Practice Address - Phone:915-533-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG10662080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
74-2205260OtherTAX IDENTIFICATION NUMBER
NMU3992OtherNEW MEXICO MEDICAID
TX132033501Medicaid
TXRH04OtherBLUE CROSS BLUE SHIELD
TXRH04OtherBLUE CROSS BLUE SHIELD
74-2205260OtherTAX IDENTIFICATION NUMBER