Healthcare Provider Details

I. General information

NPI: 1528026432
Provider Name (Legal Business Name): IRA KUMAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 W 203RD ST STE 201
OLYMPIA FIELDS IL
60461-1182
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 708-679-2880
  • Fax: 708-503-3297
Mailing address:
  • Phone: 317-528-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036097252
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: