Provider Demographics
NPI:1851375935
Name:CUMMINGS, DOUGLAS M (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
Last Name:CUMMINGS
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 1:712 S TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-4211
Mailing Address - Country:US
Mailing Address - Phone:989-893-4351
Mailing Address - Fax:989-893-6412
Practice Address - Street 1:712 S TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-4211
Practice Address - Country:US
Practice Address - Phone:989-893-4351
Practice Address - Fax:989-893-6412
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059109208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4737203Medicaid
MIP00227822OtherRR MEDICARE
MI0P10700Medicare ID - Type Unspecified
MI4737203Medicaid