MEDICARE: KRISTIN K TITKO DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	2794	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480032088	OTHER	KY	RAIL ROAD MEDICARE
5	480016193	OTHER	OH	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000367064	OTHER	OH	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	310817854029	OTHER	OH	CARESOURCE
6	000000367064	OTHER	KY	ANTHEM
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	294816	OTHER	OH	AMERIGROUP

General Provider Information

NPI Number	:	1174515068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN K TITKO DPM

Provider Business Mailing Address
First Line	:	6770 CINCINNATI DAYTON RD
Second Line	:	SUITE 201
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9318
Country	:	US
Telephone Number	:	513-729-4455
Fax Number	:	513-644-4993

Provider Business Practice Location Address
First Line	:	6770 CINCINNATI DAYTON RD
Second Line	:	SUITE 201
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9318
Country	:	US
Telephone Number	:	513-729-4455
Fax Number	:	513-644-4993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	05/19/2016

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Directions to “ KRISTIN K TITKO DPM” Practice Location

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