Basic Information
Provider Information
NPI: 1902064652
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KUMAR
FirstName: VIKAS
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 851 TRAFALGAR CT STE 200E
Address2:  
City: MAITLAND
State: FL
PostalCode: 327517420
CountryCode: US
TelephoneNumber: 4076670444
FaxNumber: 4076674338
Practice Location
Address1: 1000 WATERMAN WAY
Address2:  
City: TAVARES
State: FL
PostalCode: 327785266
CountryCode: US
TelephoneNumber: 4076670444
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/29/2008
LastUpdateDate: 03/03/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/03/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XME116036FLY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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