Healthcare Provider Details

I. General information

NPI: 1396024477
Provider Name (Legal Business Name): DUANE JOSEPH EHREDT JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 EUCLID AVE
CLEVELAND OH
44103-4014
US

IV. Provider business mailing address

6000 ROCKSIDE WOODS BLVD N
INDEPENDENCE OH
44131-2330
US

V. Phone/Fax

Practice location:
  • Phone: 216-241-8654
  • Fax: 216-721-5534
Mailing address:
  • Phone: 216-231-5612
  • Fax: 216-721-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.003637
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number36.003637
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: