Individual
LALATHAKSHA M KUMBAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2711
(313) 916-2554
Mailing address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2711
(313) 916-2554
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301096740
MI
207RN0300X
Nephrology Physician
4301096740
MI
246ZN0300X
Nephrology Specialist/Technologist
4301096740
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02903726
—
NY
Enumeration date
06/04/2007
Last updated
10/11/2017
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