MEDICARE: KURT H STIVER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	01029001A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000085117	OTHER	IN	ANTHEM BCBS
3	000000195014	OTHER	IN	ANTHEM BCBS
4	000000239723	OTHER	IN	ANTHEM BCBS

General Provider Information

NPI Number	:	1134194459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURT H STIVER MD

Provider Business Mailing Address
First Line	:	710 N NILES AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46617-1924
Country	:	US
Telephone Number	:	574-647-1610
Fax Number	:	574-237-6069

Provider Business Practice Location Address
First Line	:	100 NAVARRE PL
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46601-1156
Country	:	US
Telephone Number	:	574-647-1650
Fax Number	:	574-647-1655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/25/2016

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Directions to “ KURT H STIVER MD” Practice Location

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