Provider Demographics
NPI:1639279094
Name:KUMAR, PANKAJ (MD)
Entity Type:Individual
Prefix:MR
First Name:PANKAJ
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SERVICE
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374
Mailing Address - Country:US
Mailing Address - Phone:765-935-5331
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:1100 REID PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-983-3492
Practice Address - Fax:765-983-7958
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN903830YOtherREID HOSPITAL-EKG
IN100257230AMedicaid
IN110058501OtherRR MEDICARE
IN000000109079OtherBLUE SHIELD-REID HOSPITAL
IN1639279094OtherPECOS
IN000000347061OtherANTHEM BCBS PROVIDER PIN
IN100257230Medicaid
IN100257230Medicaid
IN903830YOtherREID HOSPITAL-EKG