Provider Demographics
NPI:1558366393
Name:RETZIOS, THOMAS L (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:RETZIOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002703213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0845858Medicaid
OH0700943Medicare PIN
OH0700941Medicare PIN