Healthcare Provider Details

I. General information

NPI: 1588781579
Provider Name (Legal Business Name): UDHAY N KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 HARRIS PKWY
FORT WORTH TX
76132-4101
US

IV. Provider business mailing address

6100 HARRIS PKWY
FORT WORTH TX
76132-4101
US

V. Phone/Fax

Practice location:
  • Phone: 817-820-4906
  • Fax: 817-820-4815
Mailing address:
  • Phone: 817-820-4906
  • Fax: 817-820-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT184861
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM8102
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: