MEDICARE: ASSOCIATED FOOT AND ANKLE SPECIALISTS OF OHIO INC

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	36003238	OH

General Provider Information

NPI Number	:	1386080703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED FOOT AND ANKLE SPECIALISTS OF OHIO INC

Provider Business Mailing Address
First Line	:	6200 PLEASANT AVE
Second Line	:	SUITE 3
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-4670
Country	:	US
Telephone Number	:	513-829-9333
Fax Number	:	513-858-7827

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	:	DPM/OWNER
Name	:	MARC S GREENBERG
Credential	:	DPM
Telephone Number	:	937-427-1175

Provider Enumeration Date	:	05/13/2013
Last Update Date	:	03/22/2016

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