Healthcare Provider Details

I. General information

NPI: 1568798908
Provider Name (Legal Business Name): GENTLE FOOT CARE OF WESTERN OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 WOODWARD AVE STE 1102
DETROIT MI
48201-2061
US

IV. Provider business mailing address

3255 E LIVINGSTON AVE
COLUMBUS OH
43227-1923
US

V. Phone/Fax

Practice location:
  • Phone: 313-833-3090
  • Fax: 313-833-7843
Mailing address:
  • Phone: 614-239-0399
  • Fax: 614-237-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY SCOTT WILSON
Title or Position: PODIATRIST/PRESIDENT
Credential: DPM
Phone: 614-239-0399