Provider Demographics
NPI:1699778571
Name:CWIKLA, PAUL (DPM)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:CWIKLA
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 1:1605 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4525
Mailing Address - Country:US
Mailing Address - Phone:740-354-3883
Mailing Address - Fax:
Practice Address - Street 1:1605 E 11TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-354-3883
Practice Address - Fax:740-354-0447
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002581213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80540222Medicaid
OH0967039Medicaid
OH480031674OtherRAILROAD MEDICARE
OH0967039Medicaid