Provider Demographics
NPI:1427444215
Name:SCHMIDTKE, KEVIN W (DPM)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:SCHMIDTKE
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 1:200 WESTGATE DR STE A
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-8038
Mailing Address - Country:US
Mailing Address - Phone:910-295-7400
Mailing Address - Fax:877-295-0079
Practice Address - Street 1:200 WESTGATE DR STE A
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-8038
Practice Address - Country:US
Practice Address - Phone:910-295-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC720213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery