Healthcare Provider Details

I. General information

NPI: 1891792115
Provider Name (Legal Business Name): FRANK YANNUCCI D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 BOARDMAN CANFIELD RD BUILDING F UNIT 1
BOARDMAN OH
44512-4300
US

IV. Provider business mailing address

PO BOX 80
HUBBARD OH
44425-0080
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-3668
  • Fax: 330-726-3669
Mailing address:
  • Phone: 330-726-3668
  • Fax: 330-726-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.00-3061
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number362
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: