Provider Demographics
NPI:1952493751
Name:SVOBODA, JOSEPH A (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:SVOBODA
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 1:1133 COLLEGE AVE STE A215
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2781
Mailing Address - Country:US
Mailing Address - Phone:785-539-7664
Mailing Address - Fax:785-539-3359
Practice Address - Street 1:1133 COLLEGE AVE STE A215
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2781
Practice Address - Country:US
Practice Address - Phone:785-539-7664
Practice Address - Fax:785-539-3359
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200163213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST77060Medicare UPIN
KS015072Medicare ID - Type Unspecified
KS7031750001Medicare NSC