MEDICARE: BROCK ARMSTRONG LIDEN D.P.M.

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	213EP1101X	Primary Podiatric Medicine Podiatrist	36-00-3103-L	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00287259	OTHER		RR MEDICARE R PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7887840001	OTHER	OH	NATIONAL SUPPLIER CLEARINGHOUSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598762692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROCK ARMSTRONG LIDEN D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 693
Second Line	:
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-0693
Country	:	US
Telephone Number	:	740-474-3850
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 SHARON RD STE A
Second Line	:
City	:	CIRCLEVILLE
State	:	OH
Zip	:	43113-1498
Country	:	US
Telephone Number	:	740-474-3850
Fax Number	:	888-821-9123

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	06/08/2021

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Directions to “ BROCK ARMSTRONG LIDEN D.P.M.” Practice Location

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