Provider Demographics
NPI:1689948598
Name:DPMNUNANPROH LLC
Entity Type:Organization
Organization Name:DPMNUNANPROH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:NUNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-779-9673
Mailing Address - Street 1:4342 GALLIA ST
Mailing Address - Street 2:STE.A
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5562
Mailing Address - Country:US
Mailing Address - Phone:513-779-9673
Mailing Address - Fax:
Practice Address - Street 1:4342 GALLIA ST
Practice Address - Street 2:STE.A
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5562
Practice Address - Country:US
Practice Address - Phone:513-779-9673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2221213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT80683Medicare UPIN