Provider Demographics
NPI:1255319133
Name:KUSSEL, FERDINAND OTTO (DPM)
Entity Type:Individual
Prefix:DR
First Name:FERDINAND
Middle Name:OTTO
Last Name:KUSSEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:FRED
Other - Middle Name:OTTO
Other - Last Name:KUSSEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:2378 SUNSET POINT RD.
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765
Mailing Address - Country:US
Mailing Address - Phone:727-797-5007
Mailing Address - Fax:727-725-9737
Practice Address - Street 1:2378 SUNSET POINT RD.
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765
Practice Address - Country:US
Practice Address - Phone:727-797-5007
Practice Address - Fax:727-725-9737
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2632213E00000X
FLPO0002632213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65501BMedicare ID - Type Unspecified
FLU65770Medicare UPIN