Provider Demographics
NPI:1417931700
Name:KUMAR, SUDHIR CHANDRAMOHAN (MD)
Entity Type:Individual
Prefix:
First Name:SUDHIR
Middle Name:CHANDRAMOHAN
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 1:1221 PLEASANT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1423
Mailing Address - Country:US
Mailing Address - Phone:515-241-4200
Mailing Address - Fax:515-241-4048
Practice Address - Street 1:1221 PLEASANT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1423
Practice Address - Country:US
Practice Address - Phone:515-241-4000
Practice Address - Fax:515-282-9806
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44565207R00000X
IA34520207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04-05438OtherMEDICA
IA1417931700Medicaid
MN142196Medicaid
MNMH9041031102OtherPREFERRED ONE
MNHP35883OtherHEALTH PARTNERS
MN087M8KUOtherBLUE CROSS
MN319218100Medicaid
MN7751OtherAVERA
MN087M8KUMedicaid
MN303919OtherARAZ
MNA060OtherCHAMPUS
MN554022Medicare ID - Type Unspecified
MNA060OtherCHAMPUS
MNMH9041031102OtherPREFERRED ONE
MN087M8KUMedicare ID - Type UnspecifiedBCBS MEDICARE SUPPLEMENT
MN087M8KUMedicaid
MN7751OtherAVERA
MN303919OtherARAZ