MEDICARE: DR. SASI 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	207R00000X	Internal Medicine Physician	34479	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05410V	OTHER	FL	PTAN#
2	34479	OTHER	FL	STATE LICENSE INFORMATION

General Provider Information

NPI Number	:	1649202862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SASI KUMAR M.D.

Provider Business Mailing Address
First Line	:	389 COMMERCE PKWY
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4202
Country	:	US
Telephone Number	:	321-806-3949
Fax Number	:	321-806-3945

Provider Business Practice Location Address
First Line	:	389 COMMERCE PKWY
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4202
Country	:	US
Telephone Number	:	321-806-3949
Fax Number	:	321-806-3945

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/06/2013

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