Provider Demographics
NPI:1538166251
Name:CUMMINGS, JOHN T JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:CUMMINGS
Suffix:JR
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 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 N RITTER AVE
Practice Address - Street 2:STE #479
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3050
Practice Address - Country:US
Practice Address - Phone:317-355-1020
Practice Address - Fax:317-355-1023
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031912A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01152220OtherRAILROAD MEDICARE
IN000000764466OtherANTHEM
IN100121650AMedicaid
IN000000089297OtherANTHEM
IN0004055974OtherAETNA
INP01152220OtherRAILROAD MEDICARE
IND94389Medicare UPIN
IN236380DMedicare PIN
IN0004055974OtherAETNA
IN100121650AMedicaid