Basic Information
| Provider Information | |||||||||
| NPI: | 1063491066 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUMAR | ||||||||
| FirstName: | BIRENDRA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110105 PIONEER W TRL 302 | ||||||||
| Address2: | |||||||||
| City: | CHASKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553182680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9523615800 | ||||||||
| FaxNumber: | 9523615858 | ||||||||
| Practice Location | |||||||||
| Address1: | 1230 E MAIN ST | ||||||||
| Address2: | MANKATO CLINIC AT MAIN STREET | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560015066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 09/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 39113 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 39113 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 335L2KU | 01 | MN | BCBS | OTHER | P00211303 | 01 | RR MEDICARE | OTHER | 256514500 | 05 | MN | MEDICAID | 3600541 | 01 | MN | MEDICA | OTHER | NA2951011969 | 01 | MN | PREFERRED ONE | OTHER | 0593046 | 05 | IA | MEDICAID | 115710 | 01 | MN | UCARE | OTHER | 773738 | 01 | MN | AMERICAS PPO | OTHER | HP21623 | 01 | MN | HEALTH PARTNERS | OTHER | 41084933956001C219 | 01 | CHAMPUS | OTHER |