Provider Demographics
NPI:1508814906
Name:KUMAR, VIVEK V (DO)
Entity type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:V
Last Name:KUMAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 HEALTH PARK WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5177
Mailing Address - Country:US
Mailing Address - Phone:941-907-8951
Mailing Address - Fax:941-907-3015
Practice Address - Street 1:6310 HEALTH PARK WAY STE 120
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5177
Practice Address - Country:US
Practice Address - Phone:941-907-8951
Practice Address - Fax:941-907-3015
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13436207RI0011X, 207RC0000X
PAOS010177L207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017901810008Medicaid
PA036345GK7Medicare ID - Type Unspecified
PA0017901810008Medicaid