Provider Demographics
NPI:1629162417
Name:PODIATRY ASSOCIATES OF CINCINNATI INC
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF CINCINNATI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINSPAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-474-4450
Mailing Address - Street 1:4357 FERGUSON DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1760
Mailing Address - Country:US
Mailing Address - Phone:513-474-4450
Mailing Address - Fax:513-474-6387
Practice Address - Street 1:4357 FERGUSON DR STE 150
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1760
Practice Address - Country:US
Practice Address - Phone:513-474-4450
Practice Address - Fax:513-474-6387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2364749Medicaid
OH000000251377OtherANTHEM
CK5052OtherRAILROAD MEDICARE
OH4601360001Medicare NSC
CK5052OtherRAILROAD MEDICARE