Healthcare Provider Details

I. General information

NPI: 1760618714
Provider Name (Legal Business Name): GLENVILLE FOOT AND ANKLE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 ST. CLAIR AVE.
CLEVELAND OH
44108
US

IV. Provider business mailing address

10701 ST. CLAIR AVE.
CLEVELAND OH
44108
US

V. Phone/Fax

Practice location:
  • Phone: 216-268-0800
  • Fax: 216-268-0801
Mailing address:
  • Phone: 931-206-4362
  • Fax: 606-257-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number36003361
License Number StateOH

VIII. Authorized Official

Name: SAI MAN LEE
Title or Position: PRESIDENT
Credential: DPM
Phone: 216-268-0800