Provider Demographics
NPI:1619930922
Name:MEHNERT, JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MEHNERT
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 1:630 W MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177
Mailing Address - Country:US
Mailing Address - Phone:937-383-2311
Mailing Address - Fax:937-383-3485
Practice Address - Street 1:630 W MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177
Practice Address - Country:US
Practice Address - Phone:937-383-2311
Practice Address - Fax:937-383-3485
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002755M213ES0103X
OH36002755213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311385382OtherCOMMERIAL
OH0878886Medicaid
OH000000301132OtherBCBS
OH2700572OtherUNITED HEALTH CARE
OH480015839OtherRAILROAD
OH0878886Medicaid
OH000000301132OtherBCBS