Provider Demographics
NPI:1215750161
Name:KUMAR, ATUL (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:ATUL
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10613 MIDLAND MANOR CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-1202
Mailing Address - Country:US
Mailing Address - Phone:314-745-3028
Mailing Address - Fax:
Practice Address - Street 1:11555 CENTRAL PKWY STE 903
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2701
Practice Address - Country:US
Practice Address - Phone:863-874-0898
Practice Address - Fax:833-728-7333
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE41399390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program