MEDICARE: DR. DUANE JOSEPH EHREDT JR. 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	213ES0103X	Foot & Ankle Surgery Podiatrist	36.003637	OH
2	213ES0000X	Sports Medicine Podiatrist	36.003637	OH

General Provider Information

NPI Number	:	1396024477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUANE JOSEPH EHREDT JR. DPM

Provider Business Mailing Address
First Line	:	6000 ROCKSIDE WOODS BLVD N
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2330
Country	:	US
Telephone Number	:	216-231-5612
Fax Number	:	216-721-5534

Provider Business Practice Location Address
First Line	:	7000 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-4014
Country	:	US
Telephone Number	:	216-241-8654
Fax Number	:	216-721-5534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2011
Last Update Date	:	07/09/2024

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