Healthcare Provider Details

I. General information

NPI: 1386976744
Provider Name (Legal Business Name): OHIO FOOT AND ANKLE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4642 HILLS AND DALES RD NW
CANTON OH
44708-1510
US

IV. Provider business mailing address

3226 KENT RD
STOW OH
44224-4424
US

V. Phone/Fax

Practice location:
  • Phone: 330-477-4400
  • Fax: 330-477-2336
Mailing address:
  • Phone: 330-929-3331
  • Fax: 330-929-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003273
License Number StateOH

VIII. Authorized Official

Name: AARON J CHOKAN
Title or Position: PRESIDENT
Credential: DPM
Phone: 330-929-3331