Provider Demographics
NPI:1649258658
Name:KRISHNA KUMAR, RADHA (MD)
Entity type:Individual
Prefix:DR
First Name:RADHA
Middle Name:
Last Name:KRISHNA KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9358 ENSIGN AVE S STE C
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1474
Mailing Address - Country:US
Mailing Address - Phone:952-942-6789
Mailing Address - Fax:
Practice Address - Street 1:9358 ENSIGN AVE S STE C
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1474
Practice Address - Country:US
Practice Address - Phone:952-942-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN132376OtherUCARE
MN2316543OtherAMERICAS PPO
MN597455100Medicaid
41084933956001A037OtherCHAMPUS
MN638R2JUOtherBCBS
MN0119338OtherMEDICA
MNNA2951033182OtherPREFERRED ONE
MNHP37141OtherHEALTH PARTNERS
P00195105OtherRR MEDICARE
MN2316543OtherAMERICAS PPO
MN0119338OtherMEDICA