Healthcare Provider Details

I. General information

NPI: 1952577645
Provider Name (Legal Business Name): PRAVEEN KUMAR MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR
CHICAGO IL
60612
US

IV. Provider business mailing address

3788 MORNING STAR DRIVE
MISSISSAUGA ONTARIO
L4T 1Y6
CA

V. Phone/Fax

Practice location:
  • Phone: 888-600-2273
  • Fax:
Mailing address:
  • Phone: 905-956-2026
  • 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: