Healthcare Provider Details

I. General information

NPI: 1538166251
Provider Name (Legal Business Name): JOHN T CUMMINGS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N RITTER AVE STE #479
INDIANAPOLIS IN
46219-3050
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-1020
  • Fax: 317-355-1023
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number01031912A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: