Provider Demographics
NPI:1932381530
Name:KUMAR, SANJEEV (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJEEV
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:PO BOX 172344
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-2344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6584 POPLAR AVE
Practice Address - Street 2:STE 400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3687
Practice Address - Country:US
Practice Address - Phone:901-226-4280
Practice Address - Fax:901-226-4282
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50367207VX0201X, 207VX0201X
MN53382207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN980000069Medicare PIN
MNENROLLEDMedicaid
IAENROLLEDMedicaid