Provider Demographics
NPI:1942499504
Name:ARROWHEAD PODIATRY ASSOCIATES INC.
Entity Type:Organization
Organization Name:ARROWHEAD PODIATRY ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:BORTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-893-5757
Mailing Address - Street 1:5757 MONCLOVA RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1863
Mailing Address - Country:US
Mailing Address - Phone:419-893-5757
Mailing Address - Fax:
Practice Address - Street 1:5757 MONCLOVA RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1863
Practice Address - Country:US
Practice Address - Phone:419-893-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003428213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2882868Medicaid
OHCB1022OtherRAILROAD MEDICARE
OH9161342Medicare PIN
OHCB1022OtherRAILROAD MEDICARE