Individual
EVAN CHARLES CUMPSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
355 W 16TH ST STE 3000, INDIANAPOLIS, IN 46202-2207
(317) 963-7082
(317) 963-7085
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
01087739A
IN
207YX0901X
Otology & Neurotology Physician
Primary
01087739A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001667242
ANTHEM PTAN
IN
05
—
300062370
—
IN
Enumeration date
03/23/2016
Last updated
04/11/2025
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