Healthcare Provider Details

I. General information

NPI: 1295132793
Provider Name (Legal Business Name): OHIO PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 PEARL RD
CLEVELAND OH
44109-2750
US

IV. Provider business mailing address

3731 PEARL RD
CLEVELAND OH
44109-2750
US

V. Phone/Fax

Practice location:
  • Phone: 216-459-8616
  • Fax: 216-459-0373
Mailing address:
  • Phone: 216-459-8616
  • Fax: 216-459-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.002283
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36.002283
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number36.002283
License Number StateOH

VIII. Authorized Official

Name: DR. WILLIAM E. DONAHUE JR.
Title or Position: PHYSICIAN
Credential: D.P.M.
Phone: 216-459-8616