MEDICARE: KAVITA TUMMA 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	207RG0100X	Gastroenterology Physician	4301060393	MI

Other Identifiers

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

General Provider Information

NPI Number	:	1871569095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAVITA TUMMA M.D.

Provider Business Mailing Address
First Line	:	1231 PINE GROVE AVE
Second Line	:	SUITE 2A
City	:	PORT HURON
State	:	MI
Zip	:	48060-3500
Country	:	US
Telephone Number	:	810-982-8742
Fax Number	:	810-984-8291

Provider Business Practice Location Address
First Line	:	1231 PINE GROVE AVE
Second Line	:	SUITE 2A
City	:	PORT HURON
State	:	MI
Zip	:	48060-3500
Country	:	US
Telephone Number	:	810-982-8742
Fax Number	:	810-984-8291

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	03/13/2017

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Directions to “ KAVITA TUMMA M.D.” Practice Location

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