Provider Demographics
NPI:1689108680
Name:KUMAR, VINEETH (MD)
Entity type:Individual
Prefix:DR
First Name:VINEETH
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 W RALPH HALL PKWY
Mailing Address - Street 2:STE 221
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6662
Mailing Address - Country:US
Mailing Address - Phone:972-771-9000
Mailing Address - Fax:
Practice Address - Street 1:1005 W RALPH HALL PKWY STE 221
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6662
Practice Address - Country:US
Practice Address - Phone:972-771-9000
Practice Address - Fax:972-771-9002
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS5411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program