Healthcare Provider Details

I. General information

NPI: 1154031441
Provider Name (Legal Business Name): PODIATRY ASSOCIATES OF OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 05/17/2025
Certification Date: 05/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 HAMILTON MASON RD STE 105
HAMILTON OH
45011-5545
US

IV. Provider business mailing address

9400 S CICERO AVE STE 100
OAK LAWN IL
60453-2536
US

V. Phone/Fax

Practice location:
  • Phone: 513-844-8585
  • Fax: 513-844-8769
Mailing address:
  • Phone: 708-424-3201
  • Fax: 708-424-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: NICKOLAS A MINNIE
Title or Position: MEDICAL DIRECTOR
Credential: DPM
Phone: 513-844-8585