MEDICARE: DR. SANDEEP KUMAR 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	208600000X	Surgery Physician	MD151977	OR

General Provider Information

NPI Number	:	1104025238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDEEP KUMAR M.D.

Provider Business Mailing Address
First Line	:	392 NE NORTON LN
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-8481
Country	:	US
Telephone Number	:	503-434-6060
Fax Number	:	503-435-6463

Provider Business Practice Location Address
First Line	:	392 NE NORTON LN
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-8481
Country	:	US
Telephone Number	:	503-434-6060
Fax Number	:	503-435-6463

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

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	07/30/2010

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