Healthcare Provider Details

I. General information

NPI: 1326192410
Provider Name (Legal Business Name): GEORGE M KEMPER JR DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 FULTON DR NW
CANTON OH
44718-1727
US

IV. Provider business mailing address

5454 FULTON DR NW
CANTON OH
44718-1727
US

V. Phone/Fax

Practice location:
  • Phone: 330-433-0123
  • Fax: 330-433-0702
Mailing address:
  • Phone: 330-433-0123
  • Fax: 330-433-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36002917
License Number StateOH

VIII. Authorized Official

Name: DR. GEORGE M KEMPER JR.
Title or Position: OWNER
Credential: DPM
Phone: 330-433-0123