Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | M0137 | TX |
NPI | 1003813239 |
---|---|
Provider Name | Iresh Kumar |
First Address | Frisco, TX 75034-5675 |
Second Address | Frisco, TX 75034-5675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H71528 | (02) |