Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | G1066 | TX |
NPI | 1215004726 |
---|---|
Provider Name | Dr. Satheesh Balakrishnan Kumar |
First Address | El Paso, TX 79902-4646 |
Second Address | El Paso, TX 79902-4646 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 17/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
132033501 | (05) | TX |
74-2205260 | TAX IDENTIFICATION NUMBER (01) | |
C18067 | (02) | |
RH04 | BLUE CROSS BLUE SHIELD (01) | TX |
U3992 | NEW MEXICO MEDICAID (01) | NM |