Provider Demographics
NPI:1285072454
Name:CUMPER, KEVIN FRANCIS (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:FRANCIS
Last Name:CUMPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:621 MEMORIAL DR STE 624
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1063
Practice Address - Country:US
Practice Address - Phone:574-647-8177
Practice Address - Fax:574-647-8536
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01080202A207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN261970098OtherMEDICARE PTAN
IN236040284OtherMEDICARE PTAN
IN300013875Medicaid