Provider Demographics
NPI:1851398192
Name:EMCH, KENNETH (DPM)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:EMCH
Suffix:
Gender:M
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:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:8175 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6244
Practice Address - Country:US
Practice Address - Phone:330-629-8800
Practice Address - Fax:330-758-4914
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-00-3885213E00000X
WV290213E00000X
OH36-00-2828213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01496133Medicaid
OH0940558Medicaid
WV1054389OtherWORKERS COMP
WV6420070-0099858-000Medicaid
4524850OtherAETNA
000458128OtherHIGHMARK
WV6420070-0099858-000Medicaid
WV1054389OtherWORKERS COMP
4524850OtherAETNA
0865822Medicare ID - Type Unspecified
PA01496133Medicaid
WV4060811Medicare ID - Type Unspecified
086523Medicare ID - Type Unspecified
OH0746782Medicare ID - Type Unspecified
OH0940558Medicaid
0746785Medicare ID - Type Unspecified