MEDICARE: BUCKEYE FOOT CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	36002841	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480026423	OTHER	OH	RAILROAD MEDICARE
3	DG0721	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093893380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKEYE FOOT CARE

Provider Business Mailing Address
First Line	:	14401 SNOW RD STE 102
Second Line	:
City	:	BROOK PARK
State	:	OH
Zip	:	44142-2583
Country	:	US
Telephone Number	:	216-267-0304
Fax Number	:

Provider Business Practice Location Address
First Line	:	14401 SNOW RD STE 102
Second Line	:
City	:	BROOK PARK
State	:	OH
Zip	:	44142-2583
Country	:	US
Telephone Number	:	216-267-0304
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF PODIATRY
Name	:	DR. HOWARD MYLES KIMMEL
Credential	:	DPM
Telephone Number	:	216-267-0304

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	02/05/2020

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Directions to “BUCKEYE FOOT CARE ” Practice Location

Language	Start Address	Practice Location

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