Basic Information
Provider Information
NPI: 1003294968
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KUMAR
FirstName: KRIS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1501 N CAMPBELL AVE
Address2:  
City: TUCSON
State: AZ
PostalCode: 857245040
CountryCode: US
TelephoneNumber: 5206267000
FaxNumber: 5206266020
Practice Location
Address1: 1501 N CAMPBELL AVE
Address2:  
City: TUCSON
State: AZ
PostalCode: 857245040
CountryCode: US
TelephoneNumber: 5206267000
FaxNumber: 5206266020
Other Information
ProviderEnumerationDate: 05/12/2015
LastUpdateDate: 09/20/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X007656AZY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


Home