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General NPI Number Information
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NPI Number | 1568798908
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Entity Type | Organization
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Legal Business Name | GENTLE FOOT CARE OF WESTERN OHIO
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 10/20/2009
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Provider Practice Location Address
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Address Line | 3800 WOODWARD AVE STE 1102
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City | DETROIT
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State | MI
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Zip | 48201-2061
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Country | US
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Telephone | 313-833-3090
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Fax | 313-833-7843
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Provider Business Mailing Address
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Address Line | 3255 E LIVINGSTON AVE
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City | COLUMBUS
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State | OH
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Zip | 43227-1923
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Country | US
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Telephone | 614-239-0399
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Fax | 614-237-5220
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Authorized Official
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Title or Position | PODIATRIST/PRESIDENT
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Name | JEFFREY SCOTT WILSON
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Credential | DPM
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Telephone | 614-239-0399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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