Healthcare Provider Details

I. General information

NPI: 1780620799
Provider Name (Legal Business Name): CLINTONVILLE FOOT AND ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 N HIGH ST
COLUMBUS OH
43214-3520
US

IV. Provider business mailing address

3695 N HIGH ST
COLUMBUS OH
43214-3520
US

V. Phone/Fax

Practice location:
  • Phone: 614-267-8387
  • Fax: 614-267-2250
Mailing address:
  • Phone: 614-267-8387
  • Fax: 614-267-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL L PEREZ
Title or Position: PRESIDENT/
Credential: DPM
Phone: 614-267-8387