1215931969 NPI number — KUMAR MUKERJEE MD INC

Table of content: (NPI 1215931969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215931969 NPI number — KUMAR MUKERJEE MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KUMAR MUKERJEE MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215931969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 W HARDING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45504-1341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-399-0453
Provider Business Mailing Address Fax Number:
937-399-2847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 W HARDING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45504-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-399-0453
Provider Business Practice Location Address Fax Number:
937-399-2847
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MUKERJEE
Authorized Official First Name:
KUMAR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
937-399-0453

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  35035615M , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2920111 . This is a "UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 100007296 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000008671 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000008671 . This is a "ONE NATION INSURANCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0277365 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 280562303003 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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