Individual
RODNEY B. KUSUMI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1013 N 13TH ST, LAFAYETTE, IN 47904-2011
(765) 428-8888
(765) 428-8889
Mailing address
1013 N 13TH ST, LAFAYETTE, IN 47904-2011
(765) 428-8888
(765) 428-8889
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01057576A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000341839
ANTHEM BLUE CROSS/BLUE SH
IN
05
—
200441070
—
IN
01
—
P00176469
RAILROAD MEDICARE
IN
Enumeration date
07/14/2006
Last updated
04/25/2024
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