Provider Demographics
NPI:1649410036
Name:KUMTHEKAR, PRIYA UDAY (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:UDAY
Last Name:KUMTHEKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST STE 20-100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5970
Mailing Address - Country:US
Mailing Address - Phone:312-695-4360
Mailing Address - Fax:312-695-1435
Practice Address - Street 1:675 N SAINT CLAIR ST STE 20-100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5970
Practice Address - Country:US
Practice Address - Phone:312-695-4360
Practice Address - Fax:312-695-1435
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361280542084N0400X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology