Provider Demographics
NPI:1356694053
Name:CORNERSTONE FOOT AND ANKLE INC
Entity type:Organization
Organization Name:CORNERSTONE FOOT AND ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
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:937-293-6896
Mailing Address - Street 1:15 SOUTHMOOR CIR NE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2451
Mailing Address - Country:US
Mailing Address - Phone:937-293-6896
Mailing Address - Fax:937-293-9150
Practice Address - Street 1:15 SOUTHMOOR CIR NE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2451
Practice Address - Country:US
Practice Address - Phone:937-293-6896
Practice Address - Fax:937-293-9150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003316213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074325Medicaid
OHH158510Medicare PIN
OH0074325Medicaid
OHDV2447Medicare PIN