Provider Demographics
NPI:1629062617
Name:KUMAR, THIMMIAH (M D)
Entity Type:Individual
Prefix:
First Name:THIMMIAH
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:THIMMIAH
Other - Middle Name:
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-0606
Mailing Address - Country:US
Mailing Address - Phone:352-861-8555
Mailing Address - Fax:352-304-8985
Practice Address - Street 1:1950 SW 18TH CT
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7857
Practice Address - Country:US
Practice Address - Phone:352-861-8555
Practice Address - Fax:352-304-8985
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87420174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267379700Medicaid
FL78668Medicare ID - Type Unspecified
FLF35676Medicare UPIN