Healthcare Provider Details

I. General information

NPI: 1396841532
Provider Name (Legal Business Name): PODIATRY OF HAMILTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 CINCINNATI DAYTON RD SUITE 201
LIBERTY TOWNSHIP OH
45044-9318
US

IV. Provider business mailing address

6770 CINCINNATI DAYTON RD SUITE 201
LIBERTY TOWNSHIP OH
45044-9318
US

V. Phone/Fax

Practice location:
  • Phone: 513-729-4455
  • Fax: 513-644-4993
Mailing address:
  • Phone: 513-729-4455
  • Fax: 513-644-4993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1359
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2794
License Number StateOH

VIII. Authorized Official

Name: MRS. LONA K. BELTZ
Title or Position: PRACTICE ADMINISTRATOR
Credential: MBA
Phone: 513-644-7913