Provider Demographics
NPI:1891017257
Name:BLUFFTON FOOT AND ANKLE
Entity Type:Organization
Organization Name:BLUFFTON FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-358-3050
Mailing Address - Street 1:148 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817-1246
Mailing Address - Country:US
Mailing Address - Phone:419-358-3050
Mailing Address - Fax:
Practice Address - Street 1:148 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1246
Practice Address - Country:US
Practice Address - Phone:419-358-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003451213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3034362Medicaid
OH9387991Medicare PIN
OHDQ5581Medicare PIN
OH3034362Medicaid