Provider Demographics
NPI:1679725923
Name:UDAYAKUMAR, PRABHU DEEPAK KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:PRABHU DEEPAK KUMAR
Middle Name:
Last Name:UDAYAKUMAR
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 1:1850 HICKORY ST
Mailing Address - Street 2:STE 200F
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2305
Mailing Address - Country:US
Mailing Address - Phone:325-670-4590
Mailing Address - Fax:325-670-4587
Practice Address - Street 1:1850 HICKORY ST
Practice Address - Street 2:STE 200F
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2305
Practice Address - Country:US
Practice Address - Phone:325-670-4590
Practice Address - Fax:325-670-4587
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105531207RR0500X
MN54627207RR0500X
NDRL10815390200000X
TXR9552207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNPO1053458OtherMEDICARE RAILROAD
MN660000302Medicare PIN