Provider Demographics
NPI:1447307723
Name:STEVE M. FRIDAY
Entity type:Organization
Organization Name:STEVE M. FRIDAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-372-0900
Mailing Address - Street 1:1182 N MONROE DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1620
Mailing Address - Country:US
Mailing Address - Phone:937-372-0900
Mailing Address - Fax:937-372-0929
Practice Address - Street 1:1182 N MONROE DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1620
Practice Address - Country:US
Practice Address - Phone:937-372-0900
Practice Address - Fax:937-372-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002451213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0675836Medicaid
OH0604213Medicare PIN
OH0675836Medicaid