Healthcare Provider Details

I. General information

NPI: 1265695241
Provider Name (Legal Business Name): SANTOSH KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N 22ND ST
BLAIR NE
68008-1128
US

IV. Provider business mailing address

810 N 22ND ST
BLAIR NE
68008-1128
US

V. Phone/Fax

Practice location:
  • Phone: 402-426-2182
  • Fax:
Mailing address:
  • Phone: 402-426-2182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5825
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32223
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: