Healthcare Provider Details

I. General information

NPI: 1194957993
Provider Name (Legal Business Name): URBAN PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4485 N HIGH ST
COLUMBUS OH
43214-2637
US

IV. Provider business mailing address

4485 N HIGH ST
COLUMBUS OH
43214-2637
US

V. Phone/Fax

Practice location:
  • Phone: 614-824-5336
  • Fax: 614-732-4990
Mailing address:
  • Phone: 614-824-5336
  • Fax: 614-732-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.003201
License Number StateOH

VIII. Authorized Official

Name: DR. SCOT FRANCIS BERTOLO
Title or Position: SOLE MEMBER OF LLC
Credential: D.P.M.
Phone: 614-824-5336