Provider Demographics
NPI:1750510640
Name:KUMAR, SMRUTHI SANATH (MD)
Entity Type:Individual
Prefix:DR
First Name:SMRUTHI
Middle Name:SANATH
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SMRUTHI
Other - Middle Name:
Other - Last Name:SANATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 104240
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65110-4240
Mailing Address - Country:US
Mailing Address - Phone:573-635-5264
Mailing Address - Fax:
Practice Address - Street 1:1241 W STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6023
Practice Address - Country:US
Practice Address - Phone:573-556-7704
Practice Address - Fax:573-556-1714
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019005684208000000X
IAMD-41750282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics