Individual
VINEET KUMAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0479
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 549-0479
(618) 529-0479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125.064132
IL
208M00000X
Hospitalist Physician
Primary
036139206
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MEDICARE GROUP PTAN
IL
Enumeration date
07/03/2013
Last updated
05/12/2021
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