Provider Demographics
NPI:1255853792
Name:KUMAR, VISHAL (MD)
Entity Type:Individual
Prefix:
First Name:VISHAL
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 1:8600 STATE ROUTE 91 STE 330
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7835
Mailing Address - Country:US
Mailing Address - Phone:309-691-4005
Mailing Address - Fax:
Practice Address - Street 1:8600 STATE ROUTE 91 STE 330
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7835
Practice Address - Country:US
Practice Address - Phone:309-691-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361671082086S0102X
IN01091104A2086S0102X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care