Provider Demographics
NPI:1790704807
Name:MARK STIEBY D.P.M. LLC
Entity Type:Organization
Organization Name:MARK STIEBY D.P.M. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:STIEBY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-661-4100
Mailing Address - Street 1:3012 GLENMORE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2269
Mailing Address - Country:US
Mailing Address - Phone:513-661-4100
Mailing Address - Fax:513-661-4101
Practice Address - Street 1:3012 GLENMORE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2269
Practice Address - Country:US
Practice Address - Phone:513-661-4100
Practice Address - Fax:513-661-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-3054213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty