Provider Demographics
NPI:1407898679
Name:KUMAR, SURENDRA (MD)
Entity Type:Individual
Prefix:
First Name:SURENDRA
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 1:3929 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3437
Mailing Address - Country:US
Mailing Address - Phone:419-693-4448
Mailing Address - Fax:419-693-8857
Practice Address - Street 1:3929 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3437
Practice Address - Country:US
Practice Address - Phone:419-693-4448
Practice Address - Fax:419-693-8857
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0334070Medicaid
OHKU0458721B66Medicare PIN
OH0334070Medicaid