Provider Demographics
NPI:1831380534
Name:MUKERJEE, KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:KUMAR
Middle Name:
Last Name:MUKERJEE
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 1:25 W HARDING RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1396
Mailing Address - Country:US
Mailing Address - Phone:937-399-0453
Mailing Address - Fax:937-399-2847
Practice Address - Street 1:25 W HARDING RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1396
Practice Address - Country:US
Practice Address - Phone:937-399-0453
Practice Address - Fax:937-399-2847
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035615207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0277365Medicaid
OH1215931969OtherNPI-TYPE 2
OH1215931969OtherNPI-TYPE 2