Basic Information
| Provider Information | |||||||||
| NPI: | 1295729200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUMAR | ||||||||
| FirstName: | NAVEEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5462 EMMA LAKE CT | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329342838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217524246 | ||||||||
| FaxNumber: | 3219526296 | ||||||||
| Practice Location | |||||||||
| Address1: | 5462 EMMA LAKE CT | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329342838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217524246 | ||||||||
| FaxNumber: | 3219526296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME80294 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 35331 | 01 | FL | BLUECROSS BLUESHIELD | OTHER |