Healthcare Provider Details

I. General information

NPI: 1184795205
Provider Name (Legal Business Name): MICHAEL C KUMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 COLCORD ST
SOUTH BERWICK ME
03908-1004
US

IV. Provider business mailing address

789 CENTRAL AVE
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 207-384-4949
  • Fax:
Mailing address:
  • Phone: 207-384-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD17687
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16178
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: