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NPI Code Detail

MEDICARE: DR. IDYA PRAVEEN KUMAR MD

MEDICARE: DR. IDYA PRAVEEN 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
1207R00000XInternal Medicine Physician35066270OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689677809
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IDYA PRAVEEN KUMAR MD
Provider Business Mailing Address
First Line : 4800 PAYNE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44103-2443
Country : US
Telephone Number : 216-231-7700
Fax Number : 216-231-3828
Provider Business Practice Location Address
First Line : 13301 MILES AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44105-5521
Country : US
Telephone Number : 216-751-3100
Fax Number : 216-751-2480
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 03/05/2024

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