Provider Demographics
NPI:1760131783
Name:KUMSI SREEDHAR, PRAJWAL
Entity Type:Individual
Prefix:
First Name:PRAJWAL
Middle Name:
Last Name:KUMSI SREEDHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:# 31 3RD MAIN ROAD
Mailing Address - Street 2:BANK OF BARODA 1DT FLOOR HANUMANTHANAGAR
Mailing Address - City:BANGALORE
Mailing Address - State:KARNATAKA
Mailing Address - Zip Code:560019
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:# 31 3RD MAIN ROAD
Practice Address - Street 2:BANK OF BARODA 1DT FLOOR HANUMANTHANAGAR
Practice Address - City:BANGALORE
Practice Address - State:KARNATAKA
Practice Address - Zip Code:560019
Practice Address - Country:IN
Practice Address - Phone:504-261-7459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program