Provider Demographics
NPI:1144534421
Name:NAKUM, KASHYAPKUMAR MEGHAJIBHAI (RPT)
Entity type:Individual
Prefix:MR
First Name:KASHYAPKUMAR
Middle Name:MEGHAJIBHAI
Last Name:NAKUM
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7004 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48210-2872
Mailing Address - Country:US
Mailing Address - Phone:734-306-2503
Mailing Address - Fax:888-496-5550
Practice Address - Street 1:7004 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-2872
Practice Address - Country:US
Practice Address - Phone:734-306-2503
Practice Address - Fax:888-496-5550
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501014486OtherSTATE OF MICHIGAN