Healthcare Provider Details

I. General information

NPI: 1245201698
Provider Name (Legal Business Name): KEVIN MICHAEL KUMKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CTR JBLM
TACOMA WA
98430-0001
US

IV. Provider business mailing address

MADGAN ARMY MEDICAL CTR JBLM
TACOMA WA
98430-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3214
  • Fax:
Mailing address:
  • Phone: 253-968-3214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD40747
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: