Individual
KEVIN R. STAMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2003 STULTS RD, SUITE 120, HUNTINGTON, IN 46750-1291
(260) 355-3960
(260) 355-3969
Mailing address
1234 E DUPONT RD, SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-9728
(260) 458-5664
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01046799A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000483286
ANTHEM
IN
01
—
000000550675
ANTHEM
IN
05
—
200262570
—
IN
01
—
P00465491
RAILROAD MEDICARE
IN
Enumeration date
07/12/2006
Last updated
10/17/2022
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