Provider Demographics
NPI:1952846776
Name:KACMAR-FEDORCHAK, VERONICA ALEXIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:ALEXIS
Last Name:KACMAR-FEDORCHAK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 WILLOWCREEK RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5013
Mailing Address - Country:US
Mailing Address - Phone:219-763-1680
Mailing Address - Fax:219-762-4279
Practice Address - Street 1:3215 WILLOWCREEK RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5013
Practice Address - Country:US
Practice Address - Phone:219-763-1680
Practice Address - Fax:219-762-4279
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000322A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery