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NPI Code Detail

MEDICARE: DR. VINAY KUMAR BHOOMA M.D.

MEDICARE: DR. VINAY KUMAR BHOOMA 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
1207Q00000XFamily Medicine Physician01072949AIN
2208M00000XHospitalist Physician01072949IN
3207Q00000XFamily Medicine Physician036150270IL

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 : 1730317702
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VINAY KUMAR BHOOMA M.D.
Provider Business Mailing Address
First Line : 3 SAINT ELIZABETH BLVD STE 4000
Second Line :
City : O FALLON
State : IL
Zip : 62269-1284
Country : US
Telephone Number : 618-233-5480
Fax Number : 618-222-4790
Provider Business Practice Location Address
First Line : 3 SAINT ELIZABETH BLVD STE 4000
Second Line :
City : O FALLON
State : IL
Zip : 62269-1284
Country : US
Telephone Number : 618-233-5480
Fax Number : 618-222-4790
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2009
Last Update Date : 04/08/2021

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