Basic Information
| Provider Information | |||||||||
| NPI: | 1306050786 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUMAR | ||||||||
| FirstName: | VIJAYA | ||||||||
| MiddleName: | ARUN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VIJAYA | ||||||||
| OtherFirstName: | ARUN | ||||||||
| OtherMiddleName: | KUMAR | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1150 BERKSHIRE RD | ||||||||
| Address2: | |||||||||
| City: | GROSSE POINTE PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482301341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128055449 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4201 ST. ANTIONE UHC 5D | ||||||||
| Address2: | UNIVERSITY PEDIATRICIANS | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137455260 | ||||||||
| FaxNumber: | 3139937166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 11/13/2014 | ||||||||
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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 | 207P00000X | 4301089671 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 003053 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.