Basic Information
| Provider Information | |||||||||
| NPI: | 1144244146 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUMAR | ||||||||
| FirstName: | VIJAY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 OAKMONT LN | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605595511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307892550 | ||||||||
| FaxNumber: | 6307892571 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 E ARMY TRAIL RD | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | BLOOMINGDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601082169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303070100 | ||||||||
| FaxNumber: | 6303070111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 11/17/2014 | ||||||||
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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 | 207RI0011X | 036061023 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 2233084 | 01 | IL | BCBS PROVIDER ID | OTHER | 060009558 | 01 | IL | MEDICARE -- RR | OTHER | P00395946 | 01 | IL | RAILROAD MEDICARE | OTHER | 060020112 | 01 | IL | MEDICARE -- RR | OTHER | 01618378 | 01 | IL | BCBS PROVIDER ID | OTHER | 036061023 | 05 | IL | MEDICAID |