Provider Demographics
NPI:1568490100
Name:KEVIN F SUNSHEIN DPM INC
Entity Type:Organization
Organization Name:KEVIN F SUNSHEIN DPM INC
Other - Org Name:SUNSHEIN PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:SUNSHEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-435-7477
Mailing Address - Street 1:6474 CENTERVILLE BUSINESS PKWY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2633
Mailing Address - Country:US
Mailing Address - Phone:937-435-7477
Mailing Address - Fax:937-435-6644
Practice Address - Street 1:2510 COMMONS BLVD
Practice Address - Street 2:STE 200B
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3821
Practice Address - Country:US
Practice Address - Phone:937-435-7477
Practice Address - Fax:937-435-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1117790002Medicare NSC
OH9305201Medicare PIN