=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295736189
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER K KUMMANT MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2005
-----------------------------------------------------
Last Update Date | 03/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12579 MAIN STREET STE 101
-----------------------------------------------------
City | MARTIN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41649-0910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-285-0681
-----------------------------------------------------
Fax | 606-285-9843
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 E LIBERTY ST STE 800
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-330-7818
-----------------------------------------------------
Fax | 606-330-7825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 034039-E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 46983
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------