Healthcare Provider Details

I. General information

NPI: 1043445141
Provider Name (Legal Business Name): BENJAMIN KUMOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 DELHI ST SUITE 100
DUBUQUE IA
52001-6389
US

IV. Provider business mailing address

1515 DELHI ST SUITE 100
DUBUQUE IA
52001-6389
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-9111
  • Fax:
Mailing address:
  • Phone: 563-557-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number42572
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: