Healthcare Provider Details

I. General information

NPI: 1265848089
Provider Name (Legal Business Name): MCCARTY FAMILY FOOT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33007 LAKE RD
AVON LAKE OH
44012-1440
US

IV. Provider business mailing address

33007 LAKE RD
AVON LAKE OH
44012-1440
US

V. Phone/Fax

Practice location:
  • Phone: 513-829-9333
  • Fax:
Mailing address:
  • Phone: 513-829-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003712
License Number StateOH

VIII. Authorized Official

Name: BRENDAN C MCCARTY
Title or Position: CEO
Credential: DPM
Phone: 513-829-9333