Healthcare Provider Details

I. General information

NPI: 1952851388
Provider Name (Legal Business Name): ANKLE AND FOOT CENTERS OF OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CANTON RD NW
CARROLLTON OH
44615-1009
US

IV. Provider business mailing address

3731 WHIPPLE AVE NW
CANTON OH
44718-2933
US

V. Phone/Fax

Practice location:
  • Phone: 330-627-7676
  • Fax:
Mailing address:
  • Phone: 330-493-3363
  • Fax: 440-493-3876

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: DPM
Phone: 330-627-7676