Healthcare Provider Details

I. General information

NPI: 1518087576
Provider Name (Legal Business Name): HARESH KUMAR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 HOSPITAL DRIVE SUITE 114
VICTORIA TX
77901-5701
US

IV. Provider business mailing address

2710 HOSPITAL DRIVE SUITE 114
VICTORIA TX
77901-5701
US

V. Phone/Fax

Practice location:
  • Phone: 361-582-7999
  • Fax: 361-582-7998
Mailing address:
  • Phone: 361-582-7999
  • Fax: 361-582-7998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberN1373
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: