MEDICARE: BRONDON FOOT AND ANKLE 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	213E00000X	Podiatrist	36003616	OH

General Provider Information

NPI Number	:	1417365313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRONDON FOOT AND ANKLE LLC

Provider Business Mailing Address
First Line	:	77 W ELMWOOD DR STE 311
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-4278
Country	:	US
Telephone Number	:	937-433-0444
Fax Number	:	937-433-0405

Provider Business Practice Location Address
First Line	:	27 INDIANA AVE
Second Line	:
City	:	MONROE
State	:	OH
Zip	:	45050-1146
Country	:	US
Telephone Number	:	937-433-0444
Fax Number	:	937-433-0405

Authorized Official
Title or Position	:	DPM
Name	:	MICHAEL BRONDON
Credential	:	DPM
Telephone Number	:	937-433-0444

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	02/19/2020

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Directions to “BRONDON FOOT AND ANKLE LLC ” Practice Location

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