Provider Demographics
NPI:1104823590
Name:KACHMANN, RUDY A (MD)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:A
Last Name:KACHMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 W JEFFERSON BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4128
Mailing Address - Country:US
Mailing Address - Phone:260-432-2297
Mailing Address - Fax:260-434-6420
Practice Address - Street 1:7900 W JEFFERSON BLVD STE 201
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4128
Practice Address - Country:US
Practice Address - Phone:260-432-2297
Practice Address - Fax:260-434-6420
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01019778A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN140001923OtherRR MEDICARE
OH0128909Medicaid
IN100096190Medicaid
MI2745832Medicaid
OH0128909Medicaid
OH0394137Medicare PIN
C01080Medicare UPIN
MI2745832Medicaid
IN100096190Medicaid
IN132000CMedicare PIN
OH0394136Medicare PIN
IN5506830003Medicare NSC