Provider Demographics
NPI:1649246661
Name:KUMAR, PONON DILEEP (MD)
Entity type:Individual
Prefix:
First Name:PONON
Middle Name:DILEEP
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1217 KEARNEY ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3571
Mailing Address - Country:US
Mailing Address - Phone:810-990-8302
Mailing Address - Fax:810-990-8402
Practice Address - Street 1:1217 KEARNEY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3571
Practice Address - Country:US
Practice Address - Phone:810-990-8302
Practice Address - Fax:810-990-8402
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301077324208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1649246661Medicaid
H34919Medicare UPIN
MIG46040044Medicare PIN