Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 46647 | KY |
Y | 207RP1001X | Pulmonary Disease | 46647 | KY |
NPI | 1003077934 |
---|---|
Provider Name | Carlos Enrique Kummerfeldt Fabian |
First Address | Glasgow, KY 42141-1300 |
Second Address | Glasgow, KY 42141-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 20/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100301010 | (05) | KY |