Provider Demographics
NPI:1154383941
Name:SEAVER, KIMBERLY (DPM)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:SEAVER
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 1:630 W MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2170
Mailing Address - Country:US
Mailing Address - Phone:937-383-2311
Mailing Address - Fax:937-383-3485
Practice Address - Street 1:3913 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6674
Practice Address - Country:US
Practice Address - Phone:513-727-8444
Practice Address - Fax:513-423-2677
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002811213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000301133OtherBCBS
OH0914407Medicaid
OH000000018189OtherBCBS
OH2700678OtherUNITD HEALTH CARE
OHSE0735852Medicare PIN
OH000000301133OtherBCBS