MEDICARE: DANIEL C. DUFFY, 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	213ES0103X	Foot & Ankle Surgery Podiatrist	36-00-1892D	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598946832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL C. DUFFY, DPM, INC

Provider Business Mailing Address
First Line	:	1740 COOPER FOSTER PARK RD W
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44053-4201
Country	:	US
Telephone Number	:	440-282-1221
Fax Number	:	440-960-0010

Provider Business Practice Location Address
First Line	:	445 GRISWOLD RD
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-2304
Country	:	US
Telephone Number	:	440-282-1221
Fax Number	:	440-960-0010

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARYJO DUFFY
Credential	:
Telephone Number	:	440-282-1221

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	02/25/2008

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