Healthcare Provider Details

I. General information

NPI: 1619157781
Provider Name (Legal Business Name): AUSTINTOWN PODIATRY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 SOUTH AVE
BOARDMAN OH
44512-3603
US

IV. Provider business mailing address

7010 SOUTH AVE
BOARDMAN OH
44512-3603
US

V. Phone/Fax

Practice location:
  • Phone: 330-372-1500
  • Fax: 330-372-1502
Mailing address:
  • Phone: 330-372-1500
  • Fax: 330-372-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-00-3137F
License Number StateOH

VIII. Authorized Official

Name: LAWRENCE KARLOCK
Title or Position: CEO
Credential: DPM
Phone: 330-792-6519