Healthcare Provider Details

I. General information

NPI: 1417365313
Provider Name (Legal Business Name): BRONDON FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 INDIANA AVE
MONROE OH
45050-1146
US

IV. Provider business mailing address

77 W ELMWOOD DR STE 311
DAYTON OH
45459-4278
US

V. Phone/Fax

Practice location:
  • Phone: 937-433-0444
  • Fax: 937-433-0405
Mailing address:
  • Phone: 937-433-0444
  • Fax: 937-433-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003616
License Number StateOH

VIII. Authorized Official

Name: MICHAEL BRONDON
Title or Position: DPM
Credential: DPM
Phone: 937-433-0444