Provider Demographics
NPI:1568431880
Name:KUMAR, POMILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:POMILLA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 DEVILS GLEN RD
Mailing Address - Street 2:STE 200
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7221
Mailing Address - Country:US
Mailing Address - Phone:563-332-3400
Mailing Address - Fax:563-332-4784
Practice Address - Street 1:4017 DEVILS GLEN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7221
Practice Address - Country:US
Practice Address - Phone:563-332-3400
Practice Address - Fax:563-332-4784
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA30076OtherIOWA STATE LICENSE NUMBER
IABK4199433OtherDEA
IABK4199433OtherDEA
IAI6973Medicare ID - Type UnspecifiedMEDICARE