Healthcare Provider Details

I. General information

NPI: 1962496133
Provider Name (Legal Business Name): RAKESH KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 N ARMENIA AVE SUITE #3
TAMPA FL
33603-1433
US

IV. Provider business mailing address

5106 N ARMENIA AVE SUITE #3
TAMPA FL
33603-1433
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-7463
  • Fax: 813-350-0626
Mailing address:
  • Phone: 813-877-7463
  • Fax: 813-350-0626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME78263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: