Healthcare Provider Details

I. General information

NPI: 1659064103
Provider Name (Legal Business Name): JEEVAN KUMAR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 08/23/2024
Certification Date: 05/31/2023
Deactivation Date: 01/02/2024
Reactivation Date: 08/23/2024

III. Provider practice location address

7031 SW 62 AVE
SOUTH MIAMI FL
33143
US

IV. Provider business mailing address

7031 SW 62 AVE
SOUTH MIAMI FL
33143
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-7613
  • Fax:
Mailing address:
  • Phone: 305-284-7613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: