Provider Demographics
NPI:1992776546
Name:AGGARWAL, KUMUD (MD)
Entity type:Individual
Prefix:DR
First Name:KUMUD
Middle Name:
Last Name:AGGARWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SAINT JOHN RD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7354
Mailing Address - Country:US
Mailing Address - Phone:219-879-4621
Mailing Address - Fax:219-873-2388
Practice Address - Street 1:450 SAINT JOHN RD
Practice Address - Street 2:SUITE 501
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7354
Practice Address - Country:US
Practice Address - Phone:219-879-4621
Practice Address - Fax:219-873-2388
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028750A2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL100163580AMedicaid
IN100139400AMedicaid
IN485380AMedicare ID - Type Unspecified
IL100163580AMedicaid