Basic Information
| Provider Information | |||||||||
| NPI: | 1831466796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | C SELVAKUMAR | ||||||||
| FirstName: | PRAVEEN KUMAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 EUCLID AVE | ||||||||
| Address2: | DESK A11 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164446003 | ||||||||
| FaxNumber: | 2164458241 | ||||||||
| Practice Location | |||||||||
| Address1: | 9500 EUCLID AVE | ||||||||
| Address2: | DESK A11 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164446003 | ||||||||
| FaxNumber: | 2164458241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2011 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0206X | 57.024051 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | 208000000X | 4301098413 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0206X | 0101268263 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology |
No ID Information.