MEDICARE: DR. KUMUD NIGAM M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0010100540	OTHER	IL	BCBS
2	20027734	OTHER		PALMETTO

General Provider Information

NPI Number	:	1073610051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KUMUD NIGAM M.D.

Provider Business Mailing Address
First Line	:	6957 OLDE CREEK RD
Second Line	:	SUITE #3400
City	:	ROCKFORD
State	:	IL
Zip	:	61114-7416
Country	:	US
Telephone Number	:	815-397-6276
Fax Number	:	815-397-2266

Provider Business Practice Location Address
First Line	:	6957 OLDE CREEK RD
Second Line	:	SUITE #3400
City	:	ROCKFORD
State	:	IL
Zip	:	61114-7416
Country	:	US
Telephone Number	:	815-397-6276
Fax Number	:	815-397-2266

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	02/15/2008

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