Basic Information
| Provider Information | |||||||||
| NPI: | 1356526156 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUMBERMACK | ||||||||
| FirstName: | KRISTOPHER | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CUMBERMACK | ||||||||
| OtherFirstName: | K.C. | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 800 ROSE STREET MN 150 | ||||||||
| Address2: | KENTUCKY CHILDREN'S HOSPITAL | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235494 | ||||||||
| FaxNumber: | 8593233499 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 ROSE STREET MN 150 | ||||||||
| Address2: | KENTUCKY CHILDREN'S HOSPITAL | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235494 | ||||||||
| FaxNumber: | 8593233499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2007 | ||||||||
| LastUpdateDate: | 11/04/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | 060362 | GA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 2080P0202X | 44022 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
No ID Information.