Provider Demographics
NPI:1154382505
Name:KRUMPELMAN, JEROME (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:KRUMPELMAN
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 1:51 BACK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444-8566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:606-877-3978
Practice Address - Street 1:51 BACK CREEK RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-8566
Practice Address - Country:US
Practice Address - Phone:859-339-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16265208D00000X
TN208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC16200OtherCUMBERLAND HEALTHCARE INC
KYP00322418OtherRRMCR
KY000000390660OtherANTHEM
KY64162654Medicaid
KY50009734OtherPASSPORT HEALTH PLAN
KY000000390660OtherANTHEM
KYC71855Medicare UPIN