Provider Demographics
NPI:1932134590
Name:STAMM, KEVIN R (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:STAMM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1234 E DUPONT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9728
Mailing Address - Fax:260-458-5664
Practice Address - Street 1:2003 STULTS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1291
Practice Address - Country:US
Practice Address - Phone:260-355-3960
Practice Address - Fax:260-355-3969
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01046799A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000550675OtherANTHEM
IN200262570Medicaid
INP00465491OtherRAILROAD MEDICARE
IN000000483286OtherANTHEM
INP00465491OtherRAILROAD MEDICARE
H25671Medicare UPIN
IN200262570Medicaid