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General NPI Number Information
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NPI Number | 1629208103
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Entity Type | Individual
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Provider Name | KENNETH P STUMPF D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 6626 E 75TH ST STE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2805
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Country | US
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Telephone | 317-621-7584
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Fax | 317-574-5185
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Provider Business Mailing Address
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Address Line | 3077 E 98TH ST STE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46280-2940
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Country | US
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Telephone | 317-843-2613
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Fax | 317-574-5185
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 07001125A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 41000235A
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License Number State | IN
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