Provider Demographics
NPI:1730130329
Name:KINSMAN FOOT & ANKLE CENTER INC
Entity Type:Organization
Organization Name:KINSMAN FOOT & ANKLE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARIED
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNTASER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-283-2800
Mailing Address - Street 1:11602 KINSMAN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4318
Mailing Address - Country:US
Mailing Address - Phone:216-283-2800
Mailing Address - Fax:216-283-1324
Practice Address - Street 1:11602 KINSMAN RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-4318
Practice Address - Country:US
Practice Address - Phone:216-283-2800
Practice Address - Fax:216-283-1324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003302213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2624173Medicaid
1427019074Medicare PIN
OH2624173Medicaid
1457553935Medicare NSC