Provider Demographics
NPI:1811201908
Name:SURESTEP FOOT & ANKLE MEDICAL CENTER LLC
Entity type:Organization
Organization Name:SURESTEP FOOT & ANKLE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRARENS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-489-2400
Mailing Address - Street 1:11821 MASON MONTGOMERY RD # 4B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-3705
Mailing Address - Country:US
Mailing Address - Phone:513-489-2400
Mailing Address - Fax:513-489-2455
Practice Address - Street 1:11821 MASON MONTGOMERY RD # 4B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-3705
Practice Address - Country:US
Practice Address - Phone:513-489-2400
Practice Address - Fax:513-489-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003288213E00000X
213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3102056Medicaid
OH9390301Medicare PIN
OHDR1836Medicare PIN
OHV01041Medicare UPIN
OH3102056Medicaid