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General NPI Number Information
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NPI Number | 1225219462
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Entity Type | Individual
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Provider Name | GAURAV KUMAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 3156 WILLOWCREEK RD
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City | PORTAGE
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State | IN
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Zip | 46368-4424
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Country | US
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Telephone | 219-762-9444
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 VALPARAISO ST #2001 # 2001
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City | VALPARAISO
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State | IN
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Zip | 46384-2001
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Country | US
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Telephone | 219-762-9444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01065464A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 01065464A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 01065464A
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License Number State | IN
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