MEDICARE: BEAVERCREEK FOOT & ANKLE SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1366641078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAVERCREEK FOOT & ANKLE SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	3121 EVELYN DR
Second Line	:	STE 120
City	:	BEAVERCREEK
State	:	OH
Zip	:	45434-4309
Country	:	US
Telephone Number	:	937-427-1175
Fax Number	:	937-427-9494

Provider Business Practice Location Address
First Line	:	3121 EVELYN DR
Second Line	:	STE 120
City	:	BEAVERCREEK
State	:	OH
Zip	:	45434-4309
Country	:	US
Telephone Number	:	937-427-1175
Fax Number	:	937-427-9494

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN RAYMOND SCHROEDER
Credential	:	D.P.M.
Telephone Number	:	937-427-1175

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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