Provider Demographics
NPI:1902084122
Name:BEMBYNISTA, THOMAS F (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:BEMBYNISTA
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 1:10612 E 18 ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64052
Mailing Address - Country:US
Mailing Address - Phone:816-461-7755
Mailing Address - Fax:816-461-0393
Practice Address - Street 1:10612 E 18 ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64052
Practice Address - Country:US
Practice Address - Phone:816-461-7755
Practice Address - Fax:816-461-0393
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2010-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMISSOURI484213E00000X
KS196213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA645708AOtherMEDICARE MO
KSA645708EOtherMEDICARE KS
MOA645708AOtherMEDICARE MO