| NPI | 1508264680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEAU GREGORY BORTEL Physician 419-893-5757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OH 36003428) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36003428) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: OH 36003428) | |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2014-12-05 |