Individual
SUNDANCE ZXAINE KEMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3499
(765) 747-3111
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
75000098A
IN
367H00000X
Anesthesiologist Assistant
TL95
SC
367H00000X
Anesthesiologist Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M22404254
MEDICARE PTAN
IN
05
—
PENDING
—
SC
Enumeration date
12/25/2021
Last updated
08/29/2023
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