Individual
KEVIN ANTHONY CACCAMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5137 E 1100 S # 2, KEYSTONE, IN 46759-9752
(260) 346-2961
(260) 346-2961
Mailing address
5137 E 1100 S # 2, KEYSTONE, IN 46759-9752
(260) 346-2961
(260) 346-2961
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
8926571882
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201167230A
—
IN
Enumeration date
11/04/2013
Last updated
11/04/2013
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