Healthcare Provider Details

I. General information

NPI: 1003440363
Provider Name (Legal Business Name): THE LOWER EXTREMITY SPECIALTY ALLIANCE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E STATE ST
ALLIANCE OH
44601-4910
US

IV. Provider business mailing address

440 E STATE ST
ALLIANCE OH
44601-4910
US

V. Phone/Fax

Practice location:
  • Phone: 330-821-6438
  • Fax:
Mailing address:
  • Phone: 330-821-6438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID BISHOP
Title or Position: OWNER
Credential: DPM
Phone: 330-821-6438