Provider Demographics
NPI:1558341909
Name:KUMAR, BIRESH (MD)
Entity Type:Individual
Prefix:
First Name:BIRESH
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 1:5940 CROSSLAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6986
Mailing Address - Country:US
Mailing Address - Phone:254-666-2999
Mailing Address - Fax:254-666-6000
Practice Address - Street 1:5940 CROSSLAKE PKWY
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6986
Practice Address - Country:US
Practice Address - Phone:254-666-2999
Practice Address - Fax:254-666-6000
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065642208M00000X
TXN5169207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4785962Medicaid
G82162Medicare UPIN
MI4785962Medicaid