Basic Information
| Provider Information | |||||||||
| NPI: | 1295736189 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUMMANT | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E LIBERTY ST | ||||||||
| Address2: | STE 800 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063307818 | ||||||||
| FaxNumber: | 6063307825 | ||||||||
| Practice Location | |||||||||
| Address1: | 12579 MAIN STREET | ||||||||
| Address2: | STE 101 | ||||||||
| City: | MARTIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416490910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062850681 | ||||||||
| FaxNumber: | 6062859843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 03/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 034039-E | PA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 46983 | KY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0000678684 | 01 | PA | SECURITY BLUE | OTHER | 020048938 | 01 | UNITED HEALTHCARE | OTHER | 219141 | 01 | UPMC FOR YOU | OTHER | CI6850 | 01 | PA | MEDICARE RAILROAD | OTHER | K146780 | 01 | KY | MEDICARE | OTHER | 123225 | 01 | THREE RIVERS HEALTH PLAN | OTHER | 2588679 | 01 | AETNA | OTHER | 678684 | 01 | PA | HIGHMARK BC/BS | OTHER | 1517401 | 01 | GATEWAY HEALTH PLAN | OTHER | 678684 | 01 | PA | KEYSTONE HEALTH PLAN WEST | OTHER | 1911411 | 01 | PA | FIRST HEALTH | OTHER | 251828837 | 01 | DEVON HEALTH PLAN | OTHER | 0012567360003 | 05 | PA | MEDICAID | 116818 | 01 | ANTHEM BC/BS | OTHER | 219141 | 01 | UPMC | OTHER | 5007868-001 | 01 | CIGNA | OTHER | 7100312840 | 05 | KY | MEDICAID |