Provider Demographics
NPI:1124055918
Name:KIMMEL, HOWARD MYLES (DPM)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MYLES
Last Name:KIMMEL
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 1:14401 SNOW RD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2583
Mailing Address - Country:US
Mailing Address - Phone:216-267-0304
Mailing Address - Fax:216-267-1077
Practice Address - Street 1:14401 SNOW RD
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2583
Practice Address - Country:US
Practice Address - Phone:216-267-0304
Practice Address - Fax:216-267-1077
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002841213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH480026423OtherRAILROAD MEDICARE
OH0942323Medicaid
OH480026423OtherRAILROAD MEDICARE