Provider Demographics
NPI:1295774529
Name:KESHOCK, CAROL E (DPM)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:E
Last Name:KESHOCK
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:PO BOX 40450
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-0450
Mailing Address - Country:US
Mailing Address - Phone:440-871-4700
Mailing Address - Fax:440-871-4702
Practice Address - Street 1:26908 DETROIT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2398
Practice Address - Country:US
Practice Address - Phone:440-892-6655
Practice Address - Fax:440-871-9817
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002485213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0876208Medicaid
OH480027726OtherMEDICARE RAILROAD PIN
OH0709234Medicare PIN
OH0876208Medicaid