MEDICARE: BRYAN V FALLIS D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	00258	KY
2	213E00000X	Podiatrist	244160	KY
3	213E00000X	Podiatrist	36003149	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00732469	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000619072	OTHER	OH	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083606974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN V FALLIS D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 636389
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0001
Country	:	US
Telephone Number	:	513-931-0083
Fax Number	:	859-331-2449

Provider Business Practice Location Address
First Line	:	2300 CHAMBERS CENTER DR
Second Line	:	SUITE 100
City	:	FORT MITCHELL
State	:	KY
Zip	:	41017
Country	:	US
Telephone Number	:	859-331-2440
Fax Number	:	859-331-2449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	05/07/2024

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Directions to “ BRYAN V FALLIS D.P.M.” Practice Location

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