Provider Demographics
NPI:1952577645
Name:KUMAR, PRAVEEN (MBBS)
Entity type:Individual
Prefix:
First Name:PRAVEEN
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3788 MORNING STAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:MISSISSAUGA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L4T 1Y6
Mailing Address - Country:CA
Mailing Address - Phone:905-956-2026
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:888-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program