Individual
DR. KAPISTHALAM S KUMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9320 STATE ROAD 54, TRINITY, FL 34655-1808
(727) 493-2513
(727) 842-8676
Mailing address
PO BOX 102222, ATTN: CREDENTIALING, ATLANTA, GA 30368-2222
(239) 274-8200
(239) 278-3350
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
67089
FL
207RX0202X
Medical Oncology Physician
Primary
67089
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0055468
GHI
FL
05
—
062866200
—
FL
01
—
110000805
RAIL ROAD MEDICARE
FL
01
—
211275
AVMED
—
01
—
4129445
AETNA
—
01
—
51147
BC/BS
FL
01
—
5476991001
CIGNA
—
Enumeration date
06/13/2005
Last updated
08/10/2022
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