Individual
DR. VINCENT JOHN HETHERINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
6000 ROCKSIDE WOODS BLVD N, INDEPENDENCE, OH 44131-2330
(217) 707-8012
Mailing address
6000 ROCKSIDE WOODS BLVD, INDEPENDENCE, OH 44131-2330
(216) 707-8012
(216) 643-8055
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
36002554
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0728476
—
OH
05
—
1563848
—
OH
01
—
480031328
RR MEDICARE
OH
01
—
CH5179
RR MEDICARE GROUP
OH
Enumeration date
07/01/2005
Last updated
02/08/2010
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