MEDICARE: SHIVESH SRI 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	207Q00000X	Family Medicine Physician	14464	NV

General Provider Information

NPI Number	:	1235373564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIVESH SRI KUMAR M.D.

Provider Business Mailing Address
First Line	:	6090 S FORT APACHE RD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5618
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6090 S FORT APACHE RD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5618
Country	:	US
Telephone Number	:	725-735-5407
Fax Number	:

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

Provider Enumeration Date	:	04/30/2009
Last Update Date	:	09/22/2023

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