Provider Demographics
NPI:1336251354
Name:KUMAR, PARDEEP (M D)
Entity Type:Individual
Prefix:
First Name:PARDEEP
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4251
Mailing Address - Country:US
Mailing Address - Phone:812-238-0958
Mailing Address - Fax:812-238-0960
Practice Address - Street 1:420 E HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4251
Practice Address - Country:US
Practice Address - Phone:812-238-0958
Practice Address - Fax:812-238-0960
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049325A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200366190Medicaid
INH00904Medicare UPIN
IN198620AMedicare ID - Type Unspecified