Provider Demographics
NPI:1215127220
Name:SHARI L. KAMINSKY, DPM, PC
Entity type:Organization
Organization Name:SHARI L. KAMINSKY, DPM, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-355-0074
Mailing Address - Street 1:1224 GRAHAM RD STE 3010
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8028
Mailing Address - Country:US
Mailing Address - Phone:314-355-0074
Mailing Address - Fax:314-355-0337
Practice Address - Street 1:1224 GRAHAM RD
Practice Address - Street 2:SUITE 3010
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8028
Practice Address - Country:US
Practice Address - Phone:314-355-0074
Practice Address - Fax:314-355-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000648213ES0103X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500122700Medicaid
MO480033460OtherMEDICARE RAILROAD
MO258664671Medicare PIN
MO4406020001Medicare NSC
MO500122700Medicaid
MO212234671Medicare PIN