Provider Demographics
NPI:1154353324
Name:KODISH, FRANKLIN HOWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:HOWARD
Last Name:KODISH
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 1:5 SEVERANCE CIR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1566
Mailing Address - Country:US
Mailing Address - Phone:216-381-8122
Mailing Address - Fax:
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:SUITE 501
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-381-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.001997213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0472617Medicaid
OHKO0497064Medicare ID - Type Unspecified
OH0472617Medicaid