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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DB9209	OTHER	OH	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538180674
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	:	937-435-6585
Fax Number	:	937-435-6563

Provider Business Practice Location Address
First Line	:	1001 SHROYER RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-3635
Country	:	US
Telephone Number	:	937-293-8448
Fax Number	:	937-617-4840

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. LISA NICELY
Credential	:	D.P.M.
Telephone Number	:	937-293-8448

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	02/19/2020

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Directions to “ASSOCIATED FOOT AND ANKLE SPECIALISTS OF OHIO INC ” Practice Location

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