Healthcare Provider Details

I. General information

NPI: 1770929218
Provider Name (Legal Business Name): LISA KUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176
US

IV. Provider business mailing address

8900 N KENDALL DR
MIAMI FL
33176-2197
US

V. Phone/Fax

Practice location:
  • Phone: 867-543-2712
  • Fax:
Mailing address:
  • Phone: 786-596-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number137438
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: