Healthcare Provider Details

I. General information

NPI: 1003204967
Provider Name (Legal Business Name): OHIO PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7529 STATE RD SUITE B
CINCINNATI OH
45255-6409
US

IV. Provider business mailing address

7529 STATE RD SUITE B
CINCINNATI OH
45255-6409
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-6600
  • Fax: 513-232-7529
Mailing address:
  • Phone: 513-232-6600
  • Fax: 513-232-7529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36-003316
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36-003316
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number36-003316
License Number StateOH

VIII. Authorized Official

Name: DR. BRIAN A. KUVSHINIKOV
Title or Position: PODIATRIST
Credential: DPM
Phone: 513-232-6600