MEDICARE: DR. RADHA KRISHNA KUMAR MD

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	45018	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P00195105	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	132376	OTHER	MN	UCARE
2	2316543	OTHER	MN	AMERICAS PPO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	41084933956001A037	OTHER		CHAMPUS
5	638R2JU	OTHER	MN	BCBS
6	0119338	OTHER	MN	MEDICA
7	NA2951033182	OTHER	MN	PREFERRED ONE
8	HP37141	OTHER	MN	HEALTH PARTNERS

General Provider Information

NPI Number	:	1649258658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RADHA KRISHNA KUMAR MD

Provider Business Mailing Address
First Line	:	9358 ENSIGN AVE S STE C
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55438-1474
Country	:	US
Telephone Number	:	952-942-6789
Fax Number	:

Provider Business Practice Location Address
First Line	:	9358 ENSIGN AVE S STE C
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55438-1474
Country	:	US
Telephone Number	:	952-942-6789
Fax Number	:

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	12/14/2011

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