Provider Demographics
NPI:1407830151
Name:KUMAR, PARIKSHIT S (MD)
Entity Type:Individual
Prefix:DR
First Name:PARIKSHIT
Middle Name:S
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 1:465 N. HOOPER ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723
Mailing Address - Country:US
Mailing Address - Phone:989-672-1555
Mailing Address - Fax:989-672-1560
Practice Address - Street 1:465 N HOOPER ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723
Practice Address - Country:US
Practice Address - Phone:989-672-1555
Practice Address - Fax:989-672-1560
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI040369208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1780102Medicaid
MIMI6624002Medicare PIN
MI1780102Medicaid