Healthcare Provider Details

I. General information

NPI: 1922527118
Provider Name (Legal Business Name): NORTHEAST OHIO FOOT AND ANKLE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 FRANK AVE NW
CANTON OH
44720-7483
US

IV. Provider business mailing address

4900 FRANK AVE NW
CANTON OH
44720-7483
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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003689
License Number StateOH

VIII. Authorized Official

Name: DR. FRANK LUCKINO
Title or Position: OWNER
Credential: DPM
Phone: 330-477-6265