MEDICARE: ANTHONY E INNOCENZI DPM 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	36003012I	OH

General Provider Information

NPI Number	:	1386716827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY E INNOCENZI DPM INC

Provider Business Mailing Address
First Line	:	3660 STARRS CENTRE DR
Second Line	:	SUITE 3
City	:	CANFIELD
State	:	OH
Zip	:	44406-9514
Country	:	US
Telephone Number	:	330-702-0978
Fax Number	:

Provider Business Practice Location Address
First Line	:	3660 STARRS CENTRE DR
Second Line	:	SUITE 3
City	:	CANFIELD
State	:	OH
Zip	:	44406-9514
Country	:	US
Telephone Number	:	330-702-0978
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY EDWARD INNOCENZI
Credential	:	DPM
Telephone Number	:	330-702-0978

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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