Organization
REYNOLDSBURG PODIATRY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROCK A LIDEN D.P.M. (PHYSICIAN - MEMBER)
(614) 866-3182
Entity
Organization
Contact information
Practice address
7509 E MAIN ST, REYNOLDSBURG, OH 43068-7268
(614) 866-3182
(614) 866-5627
Mailing address
7509 E MAIN ST, REYNOLDSBURG, OH 43068-7268
(614) 866-3182
(614) 866-5627
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2619161
—
OH
01
—
5616730001
NEW DMERC GROUP
OH
01
—
DE3472
NEW RR MEDICARE GROUP
—
Enumeration date
07/09/2006
Last updated
08/22/2020
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