Organization
CIRCLEVILLE FOOT & ANKLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROCK A LIDEN D.P.M. (PHYSICIAN - MEMBER)
(740) 474-3850
Entity
Organization
Contact information
Practice address
210 SHARON RD, SUITE A, CIRCLEVILLE, OH 43113-1498
(740) 474-3850
(740) 477-3440
Mailing address
210 SHARON RD, P.O.BOX 865, CIRCLEVILLE, OH 43113-1498
(740) 474-3850
(740) 477-3440
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2619170
—
OH
01
—
5620650001
NEW DMERC C GROUP
OH
01
—
DE4073
NEW RR MEDICARE C GROUP
OH
Enumeration date
07/09/2006
Last updated
08/22/2020
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