Provider Demographics
NPI:1972558658
Name:KUMAR, PRATIMA VIJAY (MD)
Entity Type:Individual
Prefix:
First Name:PRATIMA
Middle Name:VIJAY
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRATIMA
Other - Middle Name:
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1930
Mailing Address - Country:US
Mailing Address - Phone:512-324-7000
Mailing Address - Fax:512-324-8021
Practice Address - Street 1:601 E 15TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1930
Practice Address - Country:US
Practice Address - Phone:512-324-7000
Practice Address - Fax:512-324-8021
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8781207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031063304Medicaid
TXB100486Medicare PIN
H04547Medicare UPIN