Provider Demographics
NPI:1982757324
Name:HANZEL, KEVIN THOMAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THOMAS
Last Name:HANZEL
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 1:103 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828
Mailing Address - Country:US
Mailing Address - Phone:419-678-4399
Mailing Address - Fax:419-678-4399
Practice Address - Street 1:103 S MARKET ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828
Practice Address - Country:US
Practice Address - Phone:419-678-4399
Practice Address - Fax:419-678-4399
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1906213ES0103X
OH36-00-3012-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T80472Medicare UPIN
OHHA0464225Medicare PIN
OHHA0464225Medicare ID - Type Unspecified