Healthcare Provider Details

I. General information

NPI: 1235146028
Provider Name (Legal Business Name): THOMAS D CUMMINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 BROWNSBORO PARK BLVD SUITE E
LOUISVILLE KY
40207-1298
US

IV. Provider business mailing address

516 BLANKENBAKER LN
LOUISVILLE KY
40207-1102
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-1441
  • Fax: 502-897-3234
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number26468
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number26468
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: