Provider Demographics
NPI:1063771715
Name:KIHM, CARL A (DPM)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:KIHM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 AUDUBON PLAZA DR STE 320
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1319
Mailing Address - Country:US
Mailing Address - Phone:502-893-1844
Mailing Address - Fax:502-634-3758
Practice Address - Street 1:3 AUDUBON PLAZA DR STE 320
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1319
Practice Address - Country:US
Practice Address - Phone:502-893-1844
Practice Address - Fax:502-634-3758
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001153213E00000X
KY00443213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000001009954OtherANTHEM
KY50107249OtherPASSPORT HEALTH PLAN
KY7100408080Medicaid
KY50107249OtherPASSPORT HEALTH PLAN