Healthcare Provider Details

I. General information

NPI: 1053971200
Provider Name (Legal Business Name): LAUREN DIGREGORIO DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 LEAR INDUSTRIAL PKWY STE 1A
AVON OH
44011-1380
US

IV. Provider business mailing address

1502 LEAR INDUSTRIAL PKWY STE 1A
AVON OH
44011-1380
US

V. Phone/Fax

Practice location:
  • Phone: 440-937-5400
  • Fax: 440-937-5533
Mailing address:
  • Phone: 440-937-5400
  • Fax: 440-937-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: LAUREN CARMELLA DIGREGORIO
Title or Position: OWNER
Credential: DPM
Phone: 419-202-4789