MEDICARE: PODIATRY ASSOCIATES OF OHIO

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1083699094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODIATRY ASSOCIATES OF OHIO

Provider Business Mailing Address
First Line	:	9400 S CICERO AVE STE 100
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2536
Country	:	US
Telephone Number	:	708-424-3201
Fax Number	:	708-424-5001

Provider Business Practice Location Address
First Line	:	3035 HAMILTON MASON RD
Second Line	:	SUITE 105
City	:	HAMILTON
State	:	OH
Zip	:	45011-5544
Country	:	US
Telephone Number	:	513-844-8585
Fax Number	:	513-844-8769

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	NICKOLAS A MINNIE
Credential	:	DPM
Telephone Number	:	513-844-8585

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	05/17/2025

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