Provider Demographics
NPI:1134194459
Name:STIVER, KURT H (MD)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:H
Last Name:STIVER
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 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:100 NAVARRE PL
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1156
Practice Address - Country:US
Practice Address - Phone:574-647-1650
Practice Address - Fax:574-647-1655
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029001A207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100335380AMedicaid
IN000000085117OtherANTHEM BCBS
IN000000195014OtherANTHEM BCBS
IN000000239723OtherANTHEM BCBS
IN162520024Medicare PIN
IN000000085117OtherANTHEM BCBS
IN100335380AMedicaid
INM400024459Medicare PIN
IN000000239723OtherANTHEM BCBS