Provider Demographics
NPI:1275511974
Name:KUMAR, USHARANI M (MD)
Entity Type:Individual
Prefix:
First Name:USHARANI
Middle Name:M
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265
Mailing Address - Country:US
Mailing Address - Phone:309-762-4500
Mailing Address - Fax:309-762-4661
Practice Address - Street 1:609 35TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-762-4500
Practice Address - Fax:309-762-4661
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31659207RR0500X
IL207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0937128Medicaid
IA0937128Medicaid
ILK27153Medicare PIN
F60729Medicare UPIN