Provider Demographics
NPI:1295950277
Name:KUMMER, TOBIAS (MD)
Entity type:Individual
Prefix:
First Name:TOBIAS
Middle Name:
Last Name:KUMMER
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 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13269207P00000X
RILP00808207P00000X
MN106826207P00000X
MN56611207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI12/08/2010OtherTRICARE
MA7/27/2010OtherTUFTS HEALTH PLAN
RI001670601OtherRI MEDICARE
RI08-06-2010OtherBCBSRI
MA110085562AMedicaid
RITK81222Medicaid
RI07-08-2010OtherNHPRI
RI939025129OtherRI MEDICARE GROUP
RI07-01-2010OtherUNITED HEALTHCARE
MN930004768Medicare PIN