Provider Demographics
NPI:1790871408
Name:KUMAR, MANJARI (MD)
Entity Type:Individual
Prefix:DR
First Name:MANJARI
Middle Name:
Last Name:KUMAR
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 1:200 N HAMMES
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435
Mailing Address - Country:US
Mailing Address - Phone:815-744-8253
Mailing Address - Fax:
Practice Address - Street 1:12255 S 80TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-923-7880
Practice Address - Fax:708-923-7888
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0991516762OtherBCBS
IL363827229 06OtherJOHN HANCOCK
IL7229POtherCATERPILLAR
IL213479OtherVALUE BEHAVIORAL HEALTH
IL219043OtherMAGELLAN
IL213479OtherVALUE BEHAVIORAL HEALTH
ILE18512Medicare UPIN