Organization
FOOTSOURCE MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS H LEE MD (PRESIDENT)
(614) 895-8747
Entity
Organization
Contact information
Practice address
300 POLARIS PKWY, SUITE 2000, WESTERVILLE, OH 43082-7989
(614) 895-8747
(614) 882-6503
Mailing address
300 POLARIS PKWY, SUITE 2000, WESTERVILLE, OH 43082-7989
(614) 895-8747
(614) 882-6503
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
25-901188
OH
Other
Enumeration date
07/08/2008
Last updated
12/01/2010
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