Provider Demographics
NPI:1487613675
Name:SAMS, KEVIN L (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:SAMS
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 1:6832 BIG BEAVER BLVD.
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1803
Mailing Address - Country:US
Mailing Address - Phone:724-843-7010
Mailing Address - Fax:
Practice Address - Street 1:6832 BIG BEAVER BLVD.
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1803
Practice Address - Country:US
Practice Address - Phone:724-843-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002492L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009094350001Medicaid
PA511626Medicare ID - Type Unspecified
PA0009094350001Medicaid