Healthcare Provider Details

I. General information

NPI: 1003986712
Provider Name (Legal Business Name): MARK STIEBY D.P.M. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 E MOUNT ZION RD
INDEPENDENCE KY
41051-9532
US

IV. Provider business mailing address

954 E MOUNT ZION RD
INDEPENDENCE KY
41051-9532
US

V. Phone/Fax

Practice location:
  • Phone: 513-398-8012
  • Fax: 513-398-8012
Mailing address:
  • Phone: 513-398-8012
  • Fax: 513-398-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-00-3054
License Number StateOH

VIII. Authorized Official

Name: DR. MARK ALLEN STIEBY
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 513-398-8012