Provider Demographics
NPI:1285637876
Name:KINBERG, PAUL (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KINBERG
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 1:1151 N BUCKNER BLVD
Mailing Address - Street 2:STE 304
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3405
Mailing Address - Country:US
Mailing Address - Phone:214-826-0111
Mailing Address - Fax:877-631-1566
Practice Address - Street 1:1151 N BUCKNER BLVD
Practice Address - Street 2:STE 304
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3405
Practice Address - Country:US
Practice Address - Phone:214-826-0111
Practice Address - Fax:877-631-1566
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX503213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018662901Medicaid
TXH08CG41801OtherBCBS
TXH08CG41801OtherBCBS
T14191Medicare UPIN
TX8F21957Medicare PIN
0208390001Medicare NSC