Healthcare Provider Details

I. General information

NPI: 1083619225
Provider Name (Legal Business Name): SHASHI A.M. KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/23/2006

III. Provider practice location address

4030 PEPPERWOOD CIR SW
HUNTSVILLE AL
35801-6499
US

IV. Provider business mailing address

4030 PEPPERWOOD CIR SW
HUNTSVILLE AL
35801-6499
US

V. Phone/Fax

Practice location:
  • Phone: 256-539-6536
  • Fax: 256-539-1504
Mailing address:
  • Phone: 256-539-6536
  • Fax: 256-539-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number00011996
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: