Provider Demographics
NPI:1932344041
Name:DR EBENEZER A KUMA MD PA
Entity Type:Organization
Organization Name:DR EBENEZER A KUMA MD PA
Other - Org Name:CHILDREN'S-FAMILY MEDI-CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EBENEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-625-4919
Mailing Address - Street 1:3406 TAMIAMI TRL UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8152
Mailing Address - Country:US
Mailing Address - Phone:941-625-4919
Mailing Address - Fax:
Practice Address - Street 1:3406 TAMIAMI TRL UNIT 2
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8152
Practice Address - Country:US
Practice Address - Phone:941-625-4919
Practice Address - Fax:941-625-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL56904208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1225038144OtherINDIVIDUAL NPI
FL062636800Medicaid