Provider Demographics
NPI:1891739603
Name:MEHL, BRADLEY M (DPM)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:M
Last Name:MEHL
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:1045 BEECHER XING N
Mailing Address - Street 2:STE A
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4573
Mailing Address - Country:US
Mailing Address - Phone:614-304-0019
Mailing Address - Fax:614-304-0023
Practice Address - Street 1:5920 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-6800
Practice Address - Country:US
Practice Address - Phone:614-891-9994
Practice Address - Fax:614-891-4141
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH36003306M213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2341120Medicaid
ME4107232Medicare PIN
OHH303331Medicare PIN
OH2341120Medicaid
OHU90899Medicare UPIN
OH5202200001Medicare NSC
OH7722387OtherAETNA
OH091504000009OtherCENTRAL BENEFITS
OH99686OtherNATIONWIDE
OH000000339081OtherANTHEM
OHP00152563OtherRAILROAD MEDICARE
OH2341120Medicaid