Provider Demographics
NPI:1144214529
Name:KIDDY, DANIEL DOUGLAS (DPM)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:DOUGLAS
Last Name:KIDDY
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:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-0755
Mailing Address - Country:US
Mailing Address - Phone:833-242-0100
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 755
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85252-0755
Practice Address - Country:US
Practice Address - Phone:833-242-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-000879213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO303557003Medicaid
480013628Medicare PIN
MO303557003Medicaid
U32142Medicare UPIN
0463550001Medicare NSC