Provider Demographics
NPI:1679505168
Name:KEMKAR, AJITKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:AJITKUMAR
Middle Name:
Last Name:KEMKAR
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 1:2625 EXECUTIVE PARK NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2721
Mailing Address - Country:US
Mailing Address - Phone:423-472-9341
Mailing Address - Fax:423-472-3746
Practice Address - Street 1:2625 EXECUTIVE PARK NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2721
Practice Address - Country:US
Practice Address - Phone:423-472-9341
Practice Address - Fax:423-472-3746
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD27349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3097235Medicare ID - Type Unspecified
G19966Medicare UPIN