MEDICARE: FOOT AND ANKLE INSTITUTE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	36-002891	OH
2	225100000X	Physical Therapist	36-002891	OH
3	332B00000X	Durable Medical Equipment & Medical Supplies	36-002891	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205901105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND ANKLE INSTITUTE, INC

Provider Business Mailing Address
First Line	:	1193 NORTON AVENUE
Second Line	:	SUITE D
City	:	NORTON
State	:	OH
Zip	:	44203-9526
Country	:	US
Telephone Number	:	330-825-7878
Fax Number	:	330-595-4729

Provider Business Practice Location Address
First Line	:	1193 NORTON AVENUE
Second Line	:	UNIT D
City	:	NORTON
State	:	OH
Zip	:	44203-9516
Country	:	US
Telephone Number	:	330-825-7878
Fax Number	:	330-658-3387

Authorized Official
Title or Position	:	OWNER
Name	:	JON D OLIVERIO
Credential	:	DPM
Telephone Number	:	330-825-7878

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	08/04/2017

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Directions to “FOOT AND ANKLE INSTITUTE, INC ” Practice Location

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