Basic Information
Provider Information | |||||||||
NPI: | 1770548042 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KUMAR | ||||||||
FirstName: | SONIA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6401 UNIVERSITY AVE NE | ||||||||
Address2: |   | ||||||||
City: | FRIDLEY | ||||||||
State: | MN | ||||||||
PostalCode: | 554324341 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7635725710 | ||||||||
FaxNumber: | 7635703008 | ||||||||
Practice Location | |||||||||
Address1: | 6341 UNIVERSITY AVE NE | ||||||||
Address2: |   | ||||||||
City: | FRIDLEY | ||||||||
State: | MN | ||||||||
PostalCode: | 554324946 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7635725710 | ||||||||
FaxNumber: | 7635865888 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/19/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34408 | MN | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 1M858KU | 01 | MN | BCBS OF MN | OTHER | 4258886 | 01 | MN | AETNA | OTHER | HP13752 | 01 | MN | HEALTHPARTNERS | OTHER | 1000867 | 01 | MN | PREFERRED ONE | OTHER | 20848 | 01 | MN | AMERICA'S PPO | OTHER | 6603871 | 01 | MN | MEDICA UC | OTHER | 107303 | 01 | MN | UCARE | OTHER | 0125466 | 01 | MN | MEDICA | OTHER |