Healthcare Provider Details

I. General information

NPI: 1790848190
Provider Name (Legal Business Name): KEVIN WURST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E SPRING ST SUITE 200
NEW ALBANY IN
47150-2926
US

IV. Provider business mailing address

700 E SPRING ST SUITE 200
NEW ALBANY IN
47150-2926
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-7536
  • Fax: 812-945-7542
Mailing address:
  • Phone: 812-945-7536
  • Fax: 812-945-7542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number27132
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01040034A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: