Healthcare Provider Details

I. General information

NPI: 1104016617
Provider Name (Legal Business Name): SURESH NARAYAN KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 E EMERALD AVE STE 610
KNOXVILLE TN
37917-4569
US

IV. Provider business mailing address

939 E EMERALD AVE STE 610
KNOXVILLE TN
37917-4569
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-8635
  • Fax: 865-637-9882
Mailing address:
  • Phone: 865-637-8635
  • Fax: 865-637-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD.203941
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number48630
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: