Provider Demographics
NPI:1407896996
Name:KUMAR, SHIVA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVA
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 1:3033 S 27TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3600
Mailing Address - Country:US
Mailing Address - Phone:414-908-6500
Mailing Address - Fax:414-385-2980
Practice Address - Street 1:2801 W KK RIVER PKWY
Practice Address - Street 2:SUITE 1030
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3669
Practice Address - Country:US
Practice Address - Phone:414-908-6500
Practice Address - Fax:414-385-2980
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51144-20207RI0008X
LA15623R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1460702Medicaid
WI51144-20OtherSTATE OF WI LICENSE
LA1460702Medicaid
WI006852540Medicare PIN
LA4F985Medicare ID - Type Unspecified
WI001965003Medicare PIN
WI51144-20OtherSTATE OF WI LICENSE