MEDICARE: CLINTONVILLE FOOT AND ANKLE

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

General Provider Information

NPI Number	:	1780620799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTONVILLE FOOT AND ANKLE

Provider Business Mailing Address
First Line	:	3695 N HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3520
Country	:	US
Telephone Number	:	614-267-8387
Fax Number	:	614-267-2250

Provider Business Practice Location Address
First Line	:	3695 N HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3520
Country	:	US
Telephone Number	:	614-267-8387
Fax Number	:	614-267-2250

Authorized Official
Title or Position	:	PRESIDENT/
Name	:	DR. MICHAEL L PEREZ
Credential	:	DPM
Telephone Number	:	614-267-8387

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	08/29/2017

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Directions to “CLINTONVILLE FOOT AND ANKLE ” Practice Location

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