Provider Demographics
NPI:1881966786
Name:KUMAR-WILLIG, RUCHI (DO)
Entity type:Individual
Prefix:
First Name:RUCHI
Middle Name:
Last Name:KUMAR-WILLIG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 N COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3957
Mailing Address - Country:US
Mailing Address - Phone:954-967-6550
Mailing Address - Fax:954-893-6818
Practice Address - Street 1:700 N HIATUS RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5206
Practice Address - Country:US
Practice Address - Phone:954-433-4744
Practice Address - Fax:954-885-6997
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006311200Medicaid
FL006311200Medicaid