Healthcare Provider Details

I. General information

NPI: 1770013245
Provider Name (Legal Business Name): ABHIN KUMAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 S CENTER ST STE 140
ARLINGTON TX
76014-2155
US

IV. Provider business mailing address

3050 S CENTER ST STE 140
ARLINGTON TX
76014-2155
US

V. Phone/Fax

Practice location:
  • Phone: 817-557-1006
  • Fax: 817-557-2000
Mailing address:
  • Phone: 901-390-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002679
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number871
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number692033
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: