Provider Demographics
NPI:1912118175
Name:SURENDRA M KUMAR M D PC
Entity type:Organization
Organization Name:SURENDRA M KUMAR M D PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURENDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:734-722-0004
Mailing Address - Street 1:33116 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5524
Mailing Address - Country:US
Mailing Address - Phone:734-722-0004
Mailing Address - Fax:
Practice Address - Street 1:33116 PALMER RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5524
Practice Address - Country:US
Practice Address - Phone:734-722-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-26
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISK822018208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISK822018OtherSTATE LICENSE
MI1762060Medicare ID - Type Unspecified
MIA77016Medicare UPIN
MI0822018Medicare ID - Type Unspecified