Provider Demographics
NPI:1245472075
Name:KUMAR, AMRENDRA
Entity type:Individual
Prefix:
First Name:AMRENDRA
Middle Name:
Last Name:KUMAR
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 1:101 ROYCE RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1458
Mailing Address - Country:US
Mailing Address - Phone:630-674-1187
Mailing Address - Fax:630-226-9510
Practice Address - Street 1:5625 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1349
Practice Address - Country:US
Practice Address - Phone:630-674-1187
Practice Address - Fax:630-226-9510
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005453225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist