Individual
VALIPARAMBIL BALAKRISHNAN PRAVEEN KUMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
960 AVENT DR, GRENADA, MS 38901-5230
(662) 227-7008
Mailing address
960 AVENT DR, GRENADA, MS 38901-5230
(662) 227-7008
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
23517
MS
208000000X
Pediatrics Physician
PT 12243
ND
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
23517
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07109554
—
MS
05
—
16811
—
ND
Enumeration date
03/21/2012
Last updated
05/22/2017
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