Organization Name: | DOUGLAS L KINCAID DPM |
NPI Number: | 1043558232 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN D KINCAID (OWNER) |
Mailing Address: | 6186 W Layton Ave Greenfield |
State: | WI US |
Postal Code: | 532204608 |
Phone Number: | 4142827209 |
Fax Number: | 4142829948 |
NPI Enumeration Date: | 01/22/2013 |
NPI Last Update Date: | 02/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 343 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |