Provider Demographics
NPI:1164579439
Name:FRIDAY, STEVE M
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:M
Last Name:FRIDAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 N MONROE DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1620
Mailing Address - Country:US
Mailing Address - Phone:937-372-0900
Mailing Address - Fax:937-372-0929
Practice Address - Street 1:1182 N MONROE DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1620
Practice Address - Country:US
Practice Address - Phone:937-372-0900
Practice Address - Fax:937-372-0929
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002451213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0675836Medicaid
OH0604213Medicare PIN
OHT80664Medicare UPIN
OH5409740001Medicare NSC