MEDICARE: DR. PRAVEEN KUMAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	036089967	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043264872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRAVEEN KUMAR MD

Provider Business Mailing Address
First Line	:	2500 N. STATE STREET
Second Line	:	UNIV OF MS MED CTR., NEWBORN MEDICINE
City	:	JACKSON
State	:	MS
Zip	:	39216-4505
Country	:	US
Telephone Number	:	601-815-7158
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 N. STATE STREET
Second Line	:	UNIV OF MS MED CTR., NEWBORN MEDICINE
City	:	JACKSON
State	:	MS
Zip	:	39216-4505
Country	:	US
Telephone Number	:	601-815-7158
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	01/02/2014

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