Provider Demographics
NPI:1003204967
Name:OHIO PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC
Entity type:Organization
Organization Name:OHIO PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUVSHINIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-232-6600
Mailing Address - Street 1:7529 STATE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-6409
Mailing Address - Country:US
Mailing Address - Phone:513-232-6600
Mailing Address - Fax:513-232-7529
Practice Address - Street 1:7529 STATE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-6409
Practice Address - Country:US
Practice Address - Phone:513-232-6600
Practice Address - Fax:513-232-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003316213ES0103X, 213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty