Provider Demographics
NPI:1871675009
Name:KEMPER, GEORGE MADSON JR (DPM)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MADSON
Last Name:KEMPER
Suffix:JR
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 1:5454 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-1727
Mailing Address - Country:US
Mailing Address - Phone:330-433-0123
Mailing Address - Fax:330-433-0702
Practice Address - Street 1:5454 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-1727
Practice Address - Country:US
Practice Address - Phone:330-433-0123
Practice Address - Fax:330-433-0702
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002917213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0251730Medicaid
OH0251730Medicaid
OH0804195Medicare PIN
OH4899030001Medicare NSC