Healthcare Provider Details

I. General information

NPI: 1730534918
Provider Name (Legal Business Name): ANKLE AND FOOT CENTERS OF OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 WHIPPLE AVE NW
CANTON OH
44718-2933
US

IV. Provider business mailing address

3731 WHIPPLE AVE NW
CANTON OH
44718-2933
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-3363
  • Fax:
Mailing address:
  • Phone: 330-493-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003582
License Number StateOH

VIII. Authorized Official

Name: NIKOLAY GATALYAK
Title or Position: DPM
Credential:
Phone: 330-493-3363