Provider Demographics
NPI:1578788121
Name:KUMAR, MITHILESH (AUD,CCC-A,SLP,FAAA)
Entity Type:Individual
Prefix:DR
First Name:MITHILESH
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:AUD,CCC-A,SLP,FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5438 LINDEN ROSE LN
Mailing Address - Street 2:UNIT. # 904
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-7110
Mailing Address - Country:US
Mailing Address - Phone:281-969-7901
Mailing Address - Fax:281-476-7383
Practice Address - Street 1:4501 CARTWRIGHT ROAD
Practice Address - Street 2:UNIT. 904
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459
Practice Address - Country:US
Practice Address - Phone:281-969-7901
Practice Address - Fax:281-476-7383
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80102231H00000X
TX102035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L13934Medicare PIN