Provider Demographics
NPI:1275159345
Name:BUCKEYE FOOT CARE
Entity Type:Organization
Organization Name:BUCKEYE FOOT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:MYLES
Authorized Official - Last Name:KIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-267-0304
Mailing Address - Street 1:14401 SNOW RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2583
Mailing Address - Country:US
Mailing Address - Phone:216-267-0304
Mailing Address - Fax:216-267-4932
Practice Address - Street 1:5105 SOM CENTER RD STE 102
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4203
Practice Address - Country:US
Practice Address - Phone:216-267-0304
Practice Address - Fax:216-267-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty