Provider Demographics
NPI:1801873146
Name:KUMAR, GANAPATHY K (MD)
Entity type:Individual
Prefix:DR
First Name:GANAPATHY
Middle Name:K
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GANAPATHY
Other - Middle Name:KRISHNA
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1615 W BIG WEAVER RD
Mailing Address - Street 2:STE A1
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-649-2004
Mailing Address - Fax:248-649-1369
Practice Address - Street 1:1615 W BIG WEAVER RD
Practice Address - Street 2:STE A1
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-649-2004
Practice Address - Fax:248-649-1369
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031185207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B48536Medicare UPIN
26335570101Medicare ID - Type Unspecified