Provider Demographics
NPI:1558625624
Name:KLUMB, PATCHARABHORN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATCHARABHORN
Middle Name:
Last Name:KLUMB
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 KENDALL RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1141
Mailing Address - Country:US
Mailing Address - Phone:219-588-7612
Mailing Address - Fax:
Practice Address - Street 1:1518 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4405
Practice Address - Country:US
Practice Address - Phone:940-234-2394
Practice Address - Fax:940-234-2395
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDPM TRAINING CERT.213ES0103X
TX2216213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery