Provider Demographics
NPI:1497934087
Name:BETSY BROGAN DPM INC
Entity Type:Organization
Organization Name:BETSY BROGAN DPM INC
Other - Org Name:DR., BETSY BROGAN DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-598-8324
Mailing Address - Street 1:5520 HARRISON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-2362
Mailing Address - Country:US
Mailing Address - Phone:513-598-8324
Mailing Address - Fax:513-598-8327
Practice Address - Street 1:5520 HARRISON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-2362
Practice Address - Country:US
Practice Address - Phone:513-598-8324
Practice Address - Fax:513-598-8327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-3262B213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00109971OtherRAILROAD MEDICARE
OH2404142Medicaid
OH2404142Medicaid
KY9707Medicare PIN
OH9335181Medicare PIN