Provider Demographics
NPI:1083677900
Name:JULES, KEVIN THOMAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THOMAS
Last Name:JULES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3498 HOWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-5155
Mailing Address - Country:US
Mailing Address - Phone:516-867-5663
Mailing Address - Fax:718-624-8022
Practice Address - Street 1:115 HENRY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2562
Practice Address - Country:US
Practice Address - Phone:718-624-8022
Practice Address - Fax:718-624-7727
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3753213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T51296Medicare UPIN
P41612Medicare ID - Type Unspecified