Healthcare Provider Details

I. General information

NPI: 1821414459
Provider Name (Legal Business Name): ABHINEET KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 07/21/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N EDWARD ST STE 3200
DECATUR IL
62526-4163
US

IV. Provider business mailing address

900 CATON AVE MAILBOX 198
BALTIMORE MD
21229-5201
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-3660
  • Fax: 217-876-3665
Mailing address:
  • Phone: 410-368-8858
  • Fax: 410-368-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP28757
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number64077
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: