MEDICARE: ASSOCIATED FOOT AND ANKLE SPECIALISTS, LLC

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

General Provider Information

NPI Number	:	1356518005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED FOOT AND ANKLE SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	2 PRESTIGE PL
Second Line	:	SUITE 210
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-3770
Country	:	US
Telephone Number	:	937-435-6585
Fax Number	:

Provider Business Practice Location Address
First Line	:	3121 EVELYN DR
Second Line	:	SUITE 120
City	:	BEAVERCREEK
State	:	OH
Zip	:	45434-4309
Country	:	US
Telephone Number	:	937-427-1175
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. MARC S GREENBERG
Credential	:	D.P.M.
Telephone Number	:	937-435-6585

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	05/12/2008

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