Provider Demographics
NPI:1356526156
Name:CUMBERMACK, KRISTOPHER MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:MICHAEL
Last Name:CUMBERMACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:K.C.
Other - Middle Name:
Other - Last Name:CUMBERMACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:800 ROSE STREET MN 150
Mailing Address - Street 2:KENTUCKY CHILDREN'S HOSPITAL
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0298
Mailing Address - Country:US
Mailing Address - Phone:859-323-5494
Mailing Address - Fax:859-323-3499
Practice Address - Street 1:800 ROSE STREET MN 150
Practice Address - Street 2:KENTUCKY CHILDREN'S HOSPITAL
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0298
Practice Address - Country:US
Practice Address - Phone:859-323-5494
Practice Address - Fax:859-323-3499
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0603622080P0202X
KY440222080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology