Provider Demographics
NPI:1154535466
Name:DOUGLAS L KINCAID DPM
Entity type:Organization
Organization Name:DOUGLAS L KINCAID DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGAER
Authorized Official - Prefix:
Authorized Official - First Name:MARY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-282-7209
Mailing Address - Street 1:6186 W LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4608
Mailing Address - Country:US
Mailing Address - Phone:414-282-7209
Mailing Address - Fax:414-282-9948
Practice Address - Street 1:6186 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4608
Practice Address - Country:US
Practice Address - Phone:414-282-7209
Practice Address - Fax:414-282-9948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI399213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43211100Medicaid
WI43207700Medicaid
WI43211100Medicaid
WIT62413Medicare UPIN
WI43207700Medicaid