Provider Demographics
NPI:1992117865
Name:CUMMINGS, KEITH ROBERT (DO)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ROBERT
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741515
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-1515
Mailing Address - Country:US
Mailing Address - Phone:425-814-5100
Mailing Address - Fax:425-814-5103
Practice Address - Street 1:11800 NE 128TH ST STE 300
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7211
Practice Address - Country:US
Practice Address - Phone:425-814-5100
Practice Address - Fax:425-814-5103
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10092219-1204208100000X
WAOP610812912081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2162532Medicaid