MEDICARE: SAGAR ATUL KUMAR

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	DN25123	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25123	OTHER	FL	FLORIDA LICENSE NUMBER

General Provider Information

NPI Number	:	1164982278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAGAR ATUL KUMAR

Provider Business Mailing Address
First Line	:	8247 HEDGEWOOD DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1492
Country	:	US
Telephone Number	:	904-894-6841
Fax Number	:

Provider Business Practice Location Address
First Line	:	7075 COLLINS RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-5041
Country	:	US
Telephone Number	:	904-894-6841
Fax Number	:

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

Provider Enumeration Date	:	03/23/2019
Last Update Date	:	11/16/2022

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Directions to “ SAGAR ATUL KUMAR ” Practice Location

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