Provider Demographics
NPI:1780029470
Name:AVRAMAUT, KIMBERLY ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:AVRAMAUT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:6215 OLD TROY PIKE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3785
Mailing Address - Country:US
Mailing Address - Phone:937-236-8111
Mailing Address - Fax:
Practice Address - Street 1:6215 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3785
Practice Address - Country:US
Practice Address - Phone:937-236-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH36.003760213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH178--29470Medicaid