Provider Demographics
NPI:1679663496
Name:TULARE FAMILY PRACTICE MEDICAL GROUP
Entity Type:Organization
Organization Name:TULARE FAMILY PRACTICE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ADVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:KAMBOJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-686-3421
Mailing Address - Street 1:1070 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2251
Mailing Address - Country:US
Mailing Address - Phone:559-686-0799
Mailing Address - Fax:559-686-0799
Practice Address - Street 1:1070 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2251
Practice Address - Country:US
Practice Address - Phone:559-686-0799
Practice Address - Fax:559-686-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ25906ZMedicare ID - Type Unspecified