Provider Demographics
NPI:1740379692
Name:KUMARI, NEELU (MD)
Entity Type:Individual
Prefix:
First Name:NEELU
Middle Name:
Last Name:KUMARI
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 1:5070 EAHEART CIR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7638
Mailing Address - Country:US
Mailing Address - Phone:409-347-1972
Mailing Address - Fax:409-347-1972
Practice Address - Street 1:3939 DOWLEN RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6875
Practice Address - Country:US
Practice Address - Phone:409-899-7800
Practice Address - Fax:409-898-3700
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL 8100207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1686453-01Medicaid
611136Medicare ID - Type Unspecified