MEDICARE: DR. CHANDRASHEKAR KUMBAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	01058079A	IN
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	01058079A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000297981	OTHER	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568425692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANDRASHEKAR KUMBAR MD

Provider Business Mailing Address
First Line	:	4015 GATEWAY BLVD
Second Line	:	SUITE 2120
City	:	NEWBURGH
State	:	IN
Zip	:	47630-9460
Country	:	US
Telephone Number	:	812-842-0907
Fax Number	:	812-464-4485

Provider Business Practice Location Address
First Line	:	4015 GATEWAY BLVD
Second Line	:	SUITE 2120
City	:	NEWBURGH
State	:	IN
Zip	:	47630-9460
Country	:	US
Telephone Number	:	812-842-0907
Fax Number	:	812-464-0555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	03/04/2021

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