Provider Demographics
NPI:1780856054
Name:PAUL KINBERG, D.P.M., P.A.
Entity Type:Organization
Organization Name:PAUL KINBERG, D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:214-826-0111
Mailing Address - Street 1:10611 GARLAND RD
Mailing Address - Street 2:STE 106
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2666
Mailing Address - Country:US
Mailing Address - Phone:214-826-0111
Mailing Address - Fax:214-324-7709
Practice Address - Street 1:10611 GARLAND RD
Practice Address - Street 2:STE 106
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2681
Practice Address - Country:US
Practice Address - Phone:214-826-0111
Practice Address - Fax:214-324-7709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0503213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0208390001Medicare NSC