Provider Demographics
NPI:1053722660
Name:ADVANCED FOOT AND ANKLE PHYSICIANS OF NW OHIO
Entity type:Organization
Organization Name:ADVANCED FOOT AND ANKLE PHYSICIANS OF NW OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:NADAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-474-5462
Mailing Address - Street 1:215 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1504
Mailing Address - Country:US
Mailing Address - Phone:419-474-5462
Mailing Address - Fax:419-474-4741
Practice Address - Street 1:2455 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4430
Practice Address - Country:US
Practice Address - Phone:419-474-5462
Practice Address - Fax:419-474-4741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003687213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104510Medicaid
OHH336720Medicare PIN
OH7268360001Medicare NSC
OHDU9870Medicare PIN