=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134194459
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KURT H STIVER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2006
-----------------------------------------------------
Last Update Date | 07/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 NAVARRE PL
-----------------------------------------------------
City | SOUTH BEND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46601-1156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-647-1650
-----------------------------------------------------
Fax | 574-647-1655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 N NILES AVE
-----------------------------------------------------
City | SOUTH BEND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46617-1924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-647-1610
-----------------------------------------------------
Fax | 574-237-6069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VM0101X
-----------------------------------------------------
Taxonomy Name | Maternal & Fetal Medicine Physician
-----------------------------------------------------
License Number | 01029001A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------