Healthcare Provider Details

I. General information

NPI: 1730130329
Provider Name (Legal Business Name): KINSMAN FOOT & ANKLE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11602 KINSMAN RD
CLEVELAND OH
44120-4318
US

IV. Provider business mailing address

11602 KINSMAN RD
CLEVELAND OH
44120-4318
US

V. Phone/Fax

Practice location:
  • Phone: 216-283-2800
  • Fax: 216-283-1324
Mailing address:
  • Phone: 216-283-2800
  • Fax: 216-283-1324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003302
License Number StateOH

VIII. Authorized Official

Name: FARIED MUNTASER
Title or Position: PODIATRIST/OWNER
Credential: DPM
Phone: 216-283-2800