Provider Demographics
NPI:1326147992
Name:KUMAR, SHIVANNA V (MD)
Entity Type:Individual
Prefix:
First Name:SHIVANNA
Middle Name:V
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 1:1111 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5958
Mailing Address - Country:US
Mailing Address - Phone:620-276-7689
Mailing Address - Fax:620-276-6117
Practice Address - Street 1:1111 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5958
Practice Address - Country:US
Practice Address - Phone:620-276-7689
Practice Address - Fax:620-276-6117
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04208462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry