Healthcare Provider Details

I. General information

NPI: 1679252332
Provider Name (Legal Business Name): KATHERINE KIRSCHBAUM DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 GLENWOOD DR STE 104
WINTER PARK FL
32792-3328
US

IV. Provider business mailing address

4101 CHARLOTTE AVE STE F185
NASHVILLE TN
37209-4066
US

V. Phone/Fax

Practice location:
  • Phone: 407-258-2308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: