Provider Demographics
NPI:1760542955
Name:HETMAN, RONALD C
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:HETMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 FAR HILLS AVENUE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4415
Mailing Address - Country:US
Mailing Address - Phone:937-433-0444
Mailing Address - Fax:937-433-0405
Practice Address - Street 1:7301 FAR HILLS AVENUE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4415
Practice Address - Country:US
Practice Address - Phone:937-433-0444
Practice Address - Fax:937-433-0405
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001421H213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217143Medicaid
OHHE0013072Medicare PIN
OH0217143Medicaid