Healthcare Provider Details

I. General information

NPI: 1356694053
Provider Name (Legal Business Name): CORNERSTONE FOOT AND ANKLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SOUTHMOOR CIR NE
DAYTON OH
45429-2451
US

IV. Provider business mailing address

15 SOUTHMOOR CIR NE
DAYTON OH
45429-2451
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-6896
  • Fax: 937-293-9150
Mailing address:
  • Phone: 937-293-6896
  • Fax: 937-293-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003316
License Number StateOH

VIII. Authorized Official

Name: BRIAN A KUVSHINIKOV
Title or Position: DPM
Credential: DPM
Phone: 937-293-6896