Healthcare Provider Details

I. General information

NPI: 1770782963
Provider Name (Legal Business Name): STEP LIVELY FOOT AND ANKLE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11925 LITHOPOLIS RD NW
CANAL WINCHESTER OH
43110-9585
US

IV. Provider business mailing address

1045 BEECHER XING N SUITE A
GAHANNA OH
43230-4558
US

V. Phone/Fax

Practice location:
  • Phone: 614-339-2000
  • Fax:
Mailing address:
  • Phone: 614-304-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: SONIA HUITZ
Title or Position: BILLING REPRESENTATIVE
Credential:
Phone: 614-304-0019