Provider Demographics
NPI:1326192410
Name:GEORGE M KEMPER JR DPM INC
Entity Type:Organization
Organization Name:GEORGE M KEMPER JR DPM INC
Other - Org Name:FOOT & ANKLE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEMPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-433-0123
Mailing Address - Street 1:5454 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-1727
Mailing Address - Country:US
Mailing Address - Phone:330-433-0123
Mailing Address - Fax:330-433-0702
Practice Address - Street 1:5454 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-1727
Practice Address - Country:US
Practice Address - Phone:330-433-0123
Practice Address - Fax:330-433-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002917213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0251730Medicaid
OH0104144Medicaid
OH4899030003Medicare NSC
OHDD2231Medicare PIN
OH0104144Medicaid
OH0804195Medicare PIN