Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036089967 | IL |
NPI | 1043264872 |
---|---|
Provider Name | Dr. Praveen Kumar |
First Address | Jackson, MS 39216-4505 |
Second Address | Jackson, MS 39216-4505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 02/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036089967 | (05) | IL |
F60642 | (02) |