Provider Demographics
NPI:1811685050
Name:KUMAR, MANOJ (MD)
Entity type:Individual
Prefix:
First Name:MANOJ
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 1:3333 GREEN BAY ROAD
Mailing Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE, CHICAGO MEDICAL SCHOOL
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064
Mailing Address - Country:US
Mailing Address - Phone:847-578-3227
Mailing Address - Fax:847-578-8778
Practice Address - Street 1:3333 GREEN BAY ROAD
Practice Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE, CHICAGO MEDICAL SCHOOL
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:847-578-3227
Practice Address - Fax:847-578-8778
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-11-30
Deactivation Date:2023-11-29
Deactivation Code:
Reactivation Date:2023-11-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program