Provider Demographics
NPI:1548622624
Name:VIVEK V KUMAR DO LLC
Entity type:Organization
Organization Name:VIVEK V KUMAR DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:V
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-907-8951
Mailing Address - Street 1:6310 HEALTH PARK WAY
Mailing Address - Street 2:STE 120
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5177
Mailing Address - Country:US
Mailing Address - Phone:941-907-8951
Mailing Address - Fax:941-907-3015
Practice Address - Street 1:6310 HEALTH PARK WAY
Practice Address - Street 2:STE 120
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5177
Practice Address - Country:US
Practice Address - Phone:941-907-8951
Practice Address - Fax:941-907-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13436207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS13436OtherMEDICAL LICENSE