Provider Demographics
NPI:1568741700
Name:NADAUD, KIM (DPM)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:NADAUD
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 1:215 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1504
Mailing Address - Country:US
Mailing Address - Phone:419-474-5462
Mailing Address - Fax:419-474-4741
Practice Address - Street 1:2455 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4430
Practice Address - Country:US
Practice Address - Phone:419-474-5462
Practice Address - Fax:419-474-4741
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36000698213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103069Medicaid
OHH337880Medicare PIN
OHP01358941Medicare PIN