Individual
KRISTIN RUTH TOLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Mailing address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
07001259A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07001259A
PODIATRY LICENSE
IN
01
—
135.000822
PROFESSIONAL LICENSE
IL
Enumeration date
07/18/2013
Last updated
09/25/2023
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