Provider Demographics
NPI:1770816951
Name:KUMAR, VIBHASH (MD)
Entity type:Individual
Prefix:DR
First Name:VIBHASH
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7888 GATEWAY BLVD E
Mailing Address - Street 2:2ND FLOOR(SUITE B)
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-1815
Mailing Address - Country:US
Mailing Address - Phone:312-613-7839
Mailing Address - Fax:
Practice Address - Street 1:7888 GATEWAY BLVD E
Practice Address - Street 2:2ND FLOOR, SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1815
Practice Address - Country:US
Practice Address - Phone:915-315-2584
Practice Address - Fax:915-315-2585
Is Sole Proprietor?:No
Enumeration Date:2009-09-06
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125056256208000000X
TXQ18472080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics