Provider Demographics
NPI:1205025228
Name:DR. KEVIN T. HANZEL, INC.
Entity type:Organization
Organization Name:DR. KEVIN T. HANZEL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-678-4399
Mailing Address - Street 1:103 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1706
Mailing Address - Country:US
Mailing Address - Phone:419-678-4399
Mailing Address - Fax:
Practice Address - Street 1:103 S MARKET ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-1706
Practice Address - Country:US
Practice Address - Phone:419-678-4399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1906213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHA0464225Medicare PIN