Provider Demographics
NPI:1386866853
Name:KUMAR, RAMAN (MD)
Entity Type:Individual
Prefix:
First Name:RAMAN
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 1:2 SAINT ANTHONYS WAY STE 305
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4569
Mailing Address - Country:US
Mailing Address - Phone:618-465-9024
Mailing Address - Fax:618-462-6828
Practice Address - Street 1:2 SAINT ANTHONYS WAY STE 305
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4569
Practice Address - Country:US
Practice Address - Phone:618-465-9024
Practice Address - Fax:618-462-6828
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250146208600000X, 208C00000X
PAMD461609208C00000X
IL036.148925208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery