Healthcare Provider Details

I. General information

NPI: 1215256086
Provider Name (Legal Business Name): RAKESH KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WASHINGTON AVE STE 100
EVANSVILLE IN
47714-0550
US

IV. Provider business mailing address

3900 WASHINGTON AVE STE 100
EVANSVILLE IN
47714-0550
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-6694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2012019815
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01091959A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number31144
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number35133457
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number01091959A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: