Healthcare Provider Details

I. General information

NPI: 1508175449
Provider Name (Legal Business Name): LEE MICHAEL HLAD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 BEECHER XING N STE A
GAHANNA OH
43230-4573
US

IV. Provider business mailing address

1045 BEECHER XING N SUITE A
COLUMBUS OH
43230-4573
US

V. Phone/Fax

Practice location:
  • Phone: 614-304-0019
  • Fax: 614-304-0023
Mailing address:
  • Phone: 614-478-2111
  • Fax: 614-304-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003610
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003610
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: