Healthcare Provider Details

I. General information

NPI: 1124055918
Provider Name (Legal Business Name): HOWARD MYLES KIMMEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14401 SNOW RD
BROOKPARK OH
44142-2583
US

IV. Provider business mailing address

14401 SNOW RD
BROOKPARK OH
44142-2583
US

V. Phone/Fax

Practice location:
  • Phone: 216-267-0304
  • Fax: 216-267-1077
Mailing address:
  • Phone: 216-267-0304
  • Fax: 216-267-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36002841
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: