Provider Demographics
NPI:1801945472
Name:KUMSSA, ADMASU (MD)
Entity type:Individual
Prefix:
First Name:ADMASU
Middle Name:
Last Name:KUMSSA
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 1:15900 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452
Mailing Address - Country:US
Mailing Address - Phone:708-663-3478
Mailing Address - Fax:708-663-3449
Practice Address - Street 1:15900 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452
Practice Address - Country:US
Practice Address - Phone:708-663-3478
Practice Address - Fax:708-663-3449
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-102022208M00000X
IL36102022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL93590Medicaid
IL814430Medicare ID - Type Unspecified
ILL93590Medicaid