Provider Demographics
NPI:1568640316
Name:KUMAR, SURENDRA (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:MR
First Name:SURENDRA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38393 CHURCHILL LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3775
Mailing Address - Country:US
Mailing Address - Phone:248-802-9090
Mailing Address - Fax:313-274-1244
Practice Address - Street 1:38393 CHURCHILL LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3775
Practice Address - Country:US
Practice Address - Phone:248-802-9090
Practice Address - Fax:313-274-1244
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005794225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N62920Medicare PIN