Healthcare Provider Details

I. General information

NPI: 1063517746
Provider Name (Legal Business Name): ADARSH A KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 TIMBERBROOKE DRIVE
SPRINGFIELD IL
62702
US

IV. Provider business mailing address

2040 TIMBERBROOKE DRIVE DERMATOLOGY & SKIN SURGERY
SPRINGFIELD IL
62702
US

V. Phone/Fax

Practice location:
  • Phone: 217-787-2511
  • Fax: 217-787-2513
Mailing address:
  • Phone: 217-787-2511
  • Fax: 217-787-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number3644781
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number036044781
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number036044781
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number036044781
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: