Provider Demographics
NPI:1295774529
Name:KESHOCK, CAROL (DPM)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:KESHOCK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:KESHOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 450945
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-0622
Mailing Address - Country:US
Mailing Address - Phone:216-409-2230
Mailing Address - Fax:440-866-6700
Practice Address - Street 1:8787 BROOKPARK RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-6809
Practice Address - Country:US
Practice Address - Phone:216-739-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002485213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0876208Medicaid
OH480027726OtherMEDICARE RAILROAD PIN
OH0709234Medicare PIN
OH0876208Medicaid