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General NPI Number Information
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NPI Number | 1093893380
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Entity Type | Organization
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Legal Business Name | BUCKEYE FOOT CARE
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 14401 SNOW RD STE 102
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City | BROOK PARK
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State | OH
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Zip | 44142-2583
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Country | US
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Telephone | 216-267-0304
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Fax |
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Provider Business Mailing Address
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Address Line | 14401 SNOW RD STE 102
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City | BROOK PARK
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State | OH
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Zip | 44142-2583
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Country | US
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Telephone | 216-267-0304
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PODIATRY
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Name | DR. HOWARD MYLES KIMMEL
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Credential | DPM
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Telephone | 216-267-0304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36002841
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License Number State | OH
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