Provider Demographics
NPI:1588819973
Name:KUMAR, SHOBHA
Entity Type:Individual
Prefix:
First Name:SHOBHA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHOBHA
Other - Middle Name:
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9445 W 144TH PL
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2543
Mailing Address - Country:US
Mailing Address - Phone:708-460-8081
Mailing Address - Fax:708-460-8089
Practice Address - Street 1:9445 W 144TH PL
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2543
Practice Address - Country:US
Practice Address - Phone:708-460-8081
Practice Address - Fax:708-460-8089
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-065755208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics