Provider Demographics
NPI:1730136896
Name:KUMARA, HALEKOTE N (MD)
Entity Type:Individual
Prefix:
First Name:HALEKOTE
Middle Name:N
Last Name:KUMARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HALEKOTE
Other - Middle Name:N
Other - Last Name:KUMARASHEKARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5744
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-0744
Mailing Address - Country:US
Mailing Address - Phone:210-921-2011
Mailing Address - Fax:210-923-9202
Practice Address - Street 1:102 PALO ALTO RD
Practice Address - Street 2:SUITE 133
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3758
Practice Address - Country:US
Practice Address - Phone:210-921-2011
Practice Address - Fax:210-923-9202
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5397208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110086902Medicaid
TXC18074Medicare UPIN
TXTXB103149Medicare PIN