Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 01019778A | IN |
NPI | 1104823590 |
---|---|
Provider Name | Rudy A. Kachmann |
First Address | Fort Wayne, IN 46804-4128 |
Second Address | Fort Wayne, IN 46804-4128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 14/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0128909 | (05) | OH |
100096190 | (05) | IN |
140001923 | RR MEDICARE (01) | IN |
2745832 | (05) | MI |
C01080 | (02) |