Provider Demographics
NPI:1164713541
Name:KISHMAN, LAUREN LINDSAY (DPM)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LINDSAY
Last Name:KISHMAN
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 1:224 W EXCHANGE ST
Mailing Address - Street 2:#440
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1704
Mailing Address - Country:US
Mailing Address - Phone:330-344-2663
Mailing Address - Fax:330-344-6038
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:#440
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1704
Practice Address - Country:US
Practice Address - Phone:330-344-2663
Practice Address - Fax:330-344-6038
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003701213ES0103X
OH003701213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH0104441Medicaid
OHH324990Medicare PIN