Individual
IRA KUMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3700 W 203RD ST STE 201, OLYMPIA FIELDS, IL 60461-1182
(708) 679-2880
(708) 503-3297
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036097252
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036097252
—
IL
01
—
IL5686046
MEDICARE PTAN
IL
Enumeration date
05/02/2006
Last updated
03/20/2021
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