MEDICARE: NICHOLAS D WOEBKENBERG DPM

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	36.003691	OH

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265714737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS D WOEBKENBERG DPM

Provider Business Mailing Address
First Line	:	4357 FERGUSON DR
Second Line	:	SUITE 150
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1760
Country	:	US
Telephone Number	:	513-474-4450
Fax Number	:	513-474-6387

Provider Business Practice Location Address
First Line	:	4357 FERGUSON DR
Second Line	:	SUITE 150
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1760
Country	:	US
Telephone Number	:	513-474-4450
Fax Number	:	513-474-6387

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

Provider Enumeration Date	:	09/12/2011
Last Update Date	:	06/20/2023

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