Provider Demographics
NPI:1891739603
Name:MEHL, BRADLEY M (DPM)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:M
Last Name:MEHL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1834
Mailing Address - Country:US
Mailing Address - Phone:614-257-5200
Mailing Address - Fax:614-388-7865
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-257-5200
Practice Address - Fax:614-388-7865
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003306M213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2341120Medicaid
ME4107232Medicare PIN
OHH303331Medicare PIN
OH2341120Medicaid
OHU90899Medicare UPIN
OH5202200001Medicare NSC
OH7722387OtherAETNA
OH091504000009OtherCENTRAL BENEFITS
OH99686OtherNATIONWIDE
OH000000339081OtherANTHEM
OHP00152563OtherRAILROAD MEDICARE
OH2341120Medicaid