Healthcare Provider Details

I. General information

NPI: 1730136896
Provider Name (Legal Business Name): HALEKOTE N KUMARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HALEKOTE N KUMARASHEKARA MD

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD SUITE 133
SAN ANTONIO TX
78211-3758
US

IV. Provider business mailing address

PO BOX 5744
SAN ANTONIO TX
78201-0744
US

V. Phone/Fax

Practice location:
  • Phone: 210-921-2011
  • Fax: 210-923-9202
Mailing address:
  • Phone: 210-921-2011
  • Fax: 210-923-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberE5397
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: