Healthcare Provider Details

I. General information

NPI: 1366430993
Provider Name (Legal Business Name): KUMAR P YOGESH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E LOCUST ST
DRESDEN TN
38225-1467
US

IV. Provider business mailing address

130 E LOCUST ST
DRESDEN TN
38225-1467
US

V. Phone/Fax

Practice location:
  • Phone: 731-364-3196
  • Fax: 731-364-5359
Mailing address:
  • Phone: 731-364-3196
  • Fax: 731-364-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number21214
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: