Provider Demographics
NPI:1700091220
Name:MICHAEL L CUMMINGS MD PSC
Entity Type:Organization
Organization Name:MICHAEL L CUMMINGS MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-387-6627
Mailing Address - Street 1:127 FOOTHILLS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602
Mailing Address - Country:US
Mailing Address - Phone:606-387-6627
Mailing Address - Fax:606-387-4178
Practice Address - Street 1:127 FOOTHILLS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602
Practice Address - Country:US
Practice Address - Phone:606-387-6627
Practice Address - Fax:606-387-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4400716Medicaid
KY65912750Medicaid
KY65912750Medicaid
KY1380501Medicare PIN