Provider Demographics
NPI:1346304961
Name:KOSMAHL, HERBERT E (DPM)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:E
Last Name:KOSMAHL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:795 RED BUD RD NE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-1966
Mailing Address - Country:US
Mailing Address - Phone:706-629-1852
Mailing Address - Fax:706-629-8004
Practice Address - Street 1:795 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1966
Practice Address - Country:US
Practice Address - Phone:706-629-1852
Practice Address - Fax:706-629-8004
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA154908OtherBLUE CROSS BLUE SHIELD OF GEORGIA
GA480000726OtherRAILROAD MEDICARE
GA1390435OtherCCN/FIRST HEALTH NETWORK
GA000253877BMedicaid
267333OtherGREAT WEST LIFE
2512650OtherCIGNA HEALTHCARE
GA480000726OtherRAILROAD MEDICARE
GA154908OtherBLUE CROSS BLUE SHIELD OF GEORGIA
GA000253877BMedicaid