Individual
MR. RAJEEV SHIVA KUMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
115 PORTER DR, MIDDLEBURY, VT 05753-8629
(802) 388-4001
Mailing address
30 PORTER DR, MIDDLEBURY, VT 05753-8422
(802) 388-4001
(802) 388-3474
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
042.
VT
207QG0300X
Geriatric Medicine (Family Medicine) Physician
042.0040074-COMP
VT
207R00000X
Internal Medicine Physician
2020011670
MO
207R00000X
Internal Medicine Physician
Primary
36093495
IL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
36093495
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093495
—
IL
01
—
208341
MEDICARE GROUP PTAN
IL
01
—
208342
MEDICARE GROUP PTAN
IL
01
—
F100323989
GROUP MEDICARE PTAN
IL
Enumeration date
05/05/2006
Last updated
04/22/2026
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