Provider Demographics
NPI:1962508424
Name:KUMAR, BOMMASAMUDRAM ASHWINI (MD)
Entity Type:Individual
Prefix:DR
First Name:BOMMASAMUDRAM
Middle Name:ASHWINI
Last Name:KUMAR
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 1:215 N MIDWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4320
Mailing Address - Country:US
Mailing Address - Phone:405-737-3491
Mailing Address - Fax:405-737-5956
Practice Address - Street 1:215 N MIDWEST BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4320
Practice Address - Country:US
Practice Address - Phone:405-737-3491
Practice Address - Fax:405-737-5956
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25189174400000X, 207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200096480AMedicaid
OK242700904Medicare PIN