Provider Demographics
NPI:1831466796
Name:C SELVAKUMAR, PRAVEEN KUMAR (MD,)
Entity Type:Individual
Prefix:DR
First Name:PRAVEEN KUMAR
Middle Name:
Last Name:C SELVAKUMAR
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:DESK A11
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-6003
Mailing Address - Fax:216-445-8241
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:DESK A11
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-6003
Practice Address - Fax:216-445-8241
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.0240512080P0206X
MI4301098413208000000X
VA01012682632080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty