Basic Information
| Provider Information | |||||||||
| NPI: | 1790871408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUMAR | ||||||||
| FirstName: | MANJARI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 N HAMMES | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157448253 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12255 S 80TH AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089237880 | ||||||||
| FaxNumber: | 7089237888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | IL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0991516762 | 01 | IL | BCBS | OTHER | 363827229 06 | 01 | IL | JOHN HANCOCK | OTHER | 7229P | 01 | IL | CATERPILLAR | OTHER | 213479 | 01 | IL | VALUE BEHAVIORAL HEALTH | OTHER | 219043 | 01 | IL | MAGELLAN | OTHER |