Provider Demographics
NPI:1144217993
Name:KOLENICH, VINCENT (DPM)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:KOLENICH
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 1:380 SUMMIT AVENUE
Mailing Address - Street 2:MSO PHYSICIAN BILLING
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-7776
Mailing Address - Fax:740-283-7807
Practice Address - Street 1:106 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8736
Practice Address - Country:US
Practice Address - Phone:740-695-1474
Practice Address - Fax:740-695-1817
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00336002878K213E00000X
WV00310213E00000X
OH36.002878213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0099960000Medicaid
OH0131155Medicaid
OH4398290001Medicare PIN
WV4164421Medicare PIN
OHU55063Medicare UPIN
WV0099960000Medicaid
WV0750467Medicare PIN