Provider Demographics
NPI:1982061180
Name:WIREMAN, GARRETT (DPM, ATC)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:
Last Name:WIREMAN
Suffix:
Gender:M
Credentials:DPM, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 PRIVATE ROAD 253
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669
Mailing Address - Country:US
Mailing Address - Phone:304-544-5606
Mailing Address - Fax:
Practice Address - Street 1:4121 BROWNS LN UNIT A8
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1547
Practice Address - Country:US
Practice Address - Phone:304-544-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2255A2300X
KY269726213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer