Provider Demographics
NPI:1235440215
Name:THOMAS L RETZIOS DPM INC
Entity Type:Organization
Organization Name:THOMAS L RETZIOS DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:RETZIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-223-2300
Mailing Address - Street 1:PO BOX 621015
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45262-1015
Mailing Address - Country:US
Mailing Address - Phone:937-223-2300
Mailing Address - Fax:937-223-2333
Practice Address - Street 1:2 PRESTIGE PL STE 210
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-6141
Practice Address - Country:US
Practice Address - Phone:937-223-2300
Practice Address - Fax:937-223-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2703213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3128136Medicaid
OH9390651Medicare PIN
OH3128136Medicaid