Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 67089 | FL |
N | 111NI0900X | Internist | 67089 | FL |
Y | 207RH0000X | Hematologist | 67089 | FL |
N | 207RX0202X | Medical Oncology | 67089 | FL |
NPI | 1255335758 |
---|---|
Provider Name | Dr. Kapisthalam S Kumar |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Trinity, FL 34655-1808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0055468 | GHI (01) | FL |
062866200 | (05) | FL |
110000805 | RAIL ROAD MEDICARE (01) | FL |
211275 | AVMED (01) | |
4129445 | AETNA (01) | |
51147 | BC/BS (01) | FL |
5476991001 | CIGNA (01) | |
D85909 | (02) |