1417931700 NPI number — SUDHIR CHANDRAMOHAN KUMAR MD

Table of content: YUGUO GUO (NPI 1801752068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417931700 NPI number — SUDHIR CHANDRAMOHAN KUMAR MD

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1417931700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 PLEASANT ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50309-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-241-4200
Provider Business Mailing Address Fax Number:
515-241-4048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 PLEASANT ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50309-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-241-4000
Provider Business Practice Location Address Fax Number:
515-282-9806
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  44565 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: 34520 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 087M8KU . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 04-05438 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1417931700 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 087M8KU , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7751 . This is a "AVERA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP35883 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 303919 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 319218100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: MH9041031102 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 142196 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: A060 . This is a "CHAMPUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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