Sarvadaman Jeet Kumar, MD
Individual provider Active NPI Internal Medicine Physician · Oconto, WI
NPI 1356367163 · NPPES record last updated Mar 5, 2013
Key facts
- NPI
- 1356367163
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 39805 (WI)
- Practice address
- 620 Smith Ave
Oconto, WI 54153-1080 - Phone
- (920) 496-4700
- NPI assigned
- Jul 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39805 | WI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prevea Regional Services, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 39805 | WI | Yes |
Addresses
Primary practice location
620 Smith Ave
Oconto, WI 54153-1080
Mailing address
620 Smith Ave
Oconto, WI 54153-1080
Phone (920) 496-4700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32469200 | Medicaid | WI |
Other providers in Oconto, WI
- Jessica Kerwin
- Thomas J. Knutson
- Jonathan Koby
- Susan M Koeune
- Kimberly Marie Kudwa
- Megan Lindstrom
- Thomas Lotter Sr.
- John Douglas Macdonald
- Ryan Patrick Macdonald
- Lisa Margaret Majewski
All providers in Oconto, WI · Internal Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.