Healthcare Provider Details

I. General information

NPI: 1972782944
Provider Name (Legal Business Name): CENTERVILLE PODIATRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 FAR HILLS AVE
CENTERVILLE OH
45459-4415
US

IV. Provider business mailing address

7301 FAR HILLS AVE
CENTERVILLE OH
45459-4415
US

V. Phone/Fax

Practice location:
  • Phone: 937-433-0444
  • Fax: 937-433-0405
Mailing address:
  • Phone: 937-433-0444
  • Fax: 937-433-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD C HETMAN
Title or Position: PRES
Credential: DPM
Phone: 937-433-0444