Provider Demographics
NPI:1154838498
Name:KATHLEEN TOEPP NEUHOFF, DPM, LLC
Entity Type:Organization
Organization Name:KATHLEEN TOEPP NEUHOFF, DPM, LLC
Other - Org Name:FAMILY FOOT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:TOEPP
Authorized Official - Last Name:NEUHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:574-287-5859
Mailing Address - Street 1:727 E JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2902
Mailing Address - Country:US
Mailing Address - Phone:574-287-5859
Mailing Address - Fax:574-287-4987
Practice Address - Street 1:727 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2902
Practice Address - Country:US
Practice Address - Phone:574-287-5859
Practice Address - Fax:574-287-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000788213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty