Provider Demographics
NPI:1174515068
Name:TITKO, KRISTIN K (DPM)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:K
Last Name:TITKO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 CINCINNATI DAYTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9318
Mailing Address - Country:US
Mailing Address - Phone:513-729-4455
Mailing Address - Fax:513-644-4993
Practice Address - Street 1:6770 CINCINNATI DAYTON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9318
Practice Address - Country:US
Practice Address - Phone:513-729-4455
Practice Address - Fax:513-644-4993
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2794213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY480032088OtherRAIL ROAD MEDICARE
OH000000367064OtherANTHEM
OH0962561Medicaid
OH310817854029OtherCARESOURCE
OH480016193OtherRAIL ROAD MEDICARE
KY000000367064OtherANTHEM
KY80000110Medicaid
OH294816OtherAMERIGROUP
OH000000367064OtherANTHEM
OH0950300001Medicare NSC
OH0753584Medicare PIN
OH0962561Medicaid
KY0172610001Medicare NSC