Healthcare Provider Details

I. General information

NPI: 1114928355
Provider Name (Legal Business Name): MICHAEL ROBERT MAHER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W RUSS RD
GREENVILLE OH
45331-2457
US

IV. Provider business mailing address

415 W RUSS RD
GREENVILLE OH
45331-2457
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-1244
  • Fax: 937-548-8898
Mailing address:
  • Phone: 937-548-1244
  • Fax: 937-548-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-00-3109M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: