Provider Demographics
NPI:1629208103
Name:STUMPF, KENNETH P (DPM)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:P
Last Name:STUMPF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3077 E 98TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2940
Mailing Address - Country:US
Mailing Address - Phone:317-843-2613
Mailing Address - Fax:317-574-5185
Practice Address - Street 1:6626 E 75TH ST
Practice Address - Street 2:STE 500
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2805
Practice Address - Country:US
Practice Address - Phone:317-621-7584
Practice Address - Fax:317-574-5185
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001125A213ES0103X
IN41000235A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN768265OtherBCBS
INP01405428OtherRAILROAD MEDICARE
IN201082910Medicaid
IN9348862OtherAETNA
INM400072187Medicare PIN
INP01405428OtherRAILROAD MEDICARE