Provider Demographics
NPI:1982710547
Name:KEMKER, STEPHEN E (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:E
Last Name:KEMKER
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 1:1002 N SHELBY ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-2307
Mailing Address - Country:US
Mailing Address - Phone:812-883-3627
Mailing Address - Fax:812-883-3736
Practice Address - Street 1:1002 N SHELBY ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-2307
Practice Address - Country:US
Practice Address - Phone:812-883-3627
Practice Address - Fax:812-883-3736
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039535A207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100351400AMedicaid
F42476Medicare UPIN