Provider Demographics
NPI:1699770347
Name:WEINKAM, GERALD B (DPM)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:B
Last Name:WEINKAM
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 1:8041 HOSBROOK ROAD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236
Mailing Address - Country:US
Mailing Address - Phone:513-791-5753
Mailing Address - Fax:513-791-2435
Practice Address - Street 1:8041 HOSBROOK ROAD
Practice Address - Street 2:SUITE 107
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236
Practice Address - Country:US
Practice Address - Phone:513-791-5753
Practice Address - Fax:513-791-2435
Is Sole Proprietor?:No
Enumeration Date:2005-06-18
Last Update Date:2007-12-27
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
OHOH36001517213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0158163Medicaid
OHWE4220901OtherMEDICARE PTAN
OH0158163Medicaid