Healthcare Provider Details

I. General information

NPI: 1982850525
Provider Name (Legal Business Name): RICHARD A RAABE DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 WERTZ AVE NW STE A
CANTON OH
44708
US

IV. Provider business mailing address

128 WERTZ AVE NW STE A
CANTON OH
44708-4196
US

V. Phone/Fax

Practice location:
  • Phone: 330-477-6265
  • Fax: 330-477-6306
Mailing address:
  • Phone: 330-477-6265
  • Fax: 330-477-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number1714
License Number StateOH

VIII. Authorized Official

Name: RICHARD RAABE
Title or Position: OWNER
Credential: D.P.M.
Phone: 330-477-6265