Provider Demographics
NPI:1043258445
Name:DUGANDZIC, KRISTINA (DPM)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:DUGANDZIC
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 ROCKSIDE RD STE 340
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2351
Mailing Address - Country:US
Mailing Address - Phone:330-644-4303
Mailing Address - Fax:844-269-8699
Practice Address - Street 1:6701 ROCKSIDE RD STE 340
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2351
Practice Address - Country:US
Practice Address - Phone:330-644-4303
Practice Address - Fax:844-269-8699
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006118213E00000X
OH36.003503213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10879AMedicare PIN
NY0550530001Medicare NSC