Organization
BRYAN FALLIS
Active
Other names
Progressive Podiatry
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN V FALLIS DPM (OWNER)
(859) 331-2440
Entity
Organization
Contact information
Practice address
2300 CHAMBER CENTER DR, SUITE 100, LAKESIDE PARK, KY 41017-1673
(859) 331-2440
(859) 331-2449
Mailing address
PO BOX 636389, CINCINNATI, OH 45263-0001
(859) 557-4260
(513) 557-3347
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
00258
KY
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100096290
—
KY
05
—
80000151
—
KY
Enumeration date
10/22/2009
Last updated
01/29/2020
Update your record
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