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General NPI Number Information
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NPI Number | 1851920748
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Entity Type | Individual
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Provider Name | DUSTIN CUNDIFF DO
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Gender | Male
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1300 WEST LEXINGTON AVE
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City | WINCHESTER
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State | KY
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Zip | 40391
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Country | US
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Telephone | 859-287-1098
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Fax |
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Provider Business Mailing Address
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Address Line | 2040 N SHADELAND AVE STE 220
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-1711
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Country | US
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Telephone |
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 02007213A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 05875
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 11020983A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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