Provider Demographics
NPI:1972767234
Name:BECHTOL, NICKLAUS AARON (DPM)
Entity type:Individual
Prefix:
First Name:NICKLAUS
Middle Name:AARON
Last Name:BECHTOL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 PLEASANT AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4670
Mailing Address - Country:US
Mailing Address - Phone:513-829-9333
Mailing Address - Fax:513-858-7827
Practice Address - Street 1:8563 REFUGEE RD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9639
Practice Address - Country:US
Practice Address - Phone:614-837-8000
Practice Address - Fax:614-837-5840
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003492213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2861845Medicaid
OH4241301Medicare PIN
OH2861845Medicaid
OH4241302Medicare PIN