Provider Demographics
NPI:1255387825
Name:CUMMINS, GRAYDON B (MD)
Entity type:Individual
Prefix:DR
First Name:GRAYDON
Middle Name:B
Last Name:CUMMINS
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 1:2323 LIME KILN LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3416
Mailing Address - Country:US
Mailing Address - Phone:502-339-8000
Mailing Address - Fax:
Practice Address - Street 1:245 ATWOOD ST
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-1738
Practice Address - Country:US
Practice Address - Phone:812-738-7883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051959A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN64316433Medicaid
IN1255387825Medicaid
IN64316433Medicaid
IN131180AAAAMedicare PIN