Provider Demographics
NPI:1275582900
Name:BRUMMER, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:BRUMMER
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 1:6149 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9134
Mailing Address - Country:US
Mailing Address - Phone:812-424-2020
Mailing Address - Fax:812-424-3000
Practice Address - Street 1:6149 E COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-9134
Practice Address - Country:US
Practice Address - Phone:812-424-2020
Practice Address - Fax:812-424-3000
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116693207W00000X
IN01061898A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200845610Medicaid
KY64128523Medicaid
IN200845610Medicaid
000000392173OtherANTHEM
KY64128523Medicaid
KY64128523Medicaid
P00350687Medicare ID - Type UnspecifiedRAILROAD MEDICARE