Provider Demographics
NPI:1548327067
Name:SLAMPAK, PHILLIP KENNETH (DPM)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:KENNETH
Last Name:SLAMPAK
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 1:317 WITTEN LANE
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155
Mailing Address - Country:US
Mailing Address - Phone:304-455-1562
Mailing Address - Fax:304-455-4955
Practice Address - Street 1:317 WITTEN LANE
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155
Practice Address - Country:US
Practice Address - Phone:304-455-1562
Practice Address - Fax:304-455-4955
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV339213E00000X
OH3337213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist