MEDICARE: LOUIS L. ENDRESS DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	36-001566	OH

General Provider Information

NPI Number	:	1225214125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUIS L. ENDRESS DPM

Provider Business Mailing Address
First Line	:	120 PONDVIEW CIR
Second Line	:
City	:	RITTMAN
State	:	OH
Zip	:	44270-9639
Country	:	US
Telephone Number	:	330-334-7617
Fax Number	:	330-334-6232

Provider Business Practice Location Address
First Line	:	2914 CLEVELAND RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-1655
Country	:	US
Telephone Number	:	330-262-5106
Fax Number	:	330-334-6232

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LOUIS L ENDRESS
Credential	:	DPM
Telephone Number	:	330-334-7617

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	01/10/2008

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