Healthcare Provider Details

I. General information

NPI: 1912398132
Provider Name (Legal Business Name): OHIO PODIATRIC PHYSICIANS AND SURGEONS GROUP,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8307 WINDHAM ST
GARRETTSVILLE OH
44231-9406
US

IV. Provider business mailing address

8307 WINDHAM ST
GARRETTSVILLE OH
44231-9406
US

V. Phone/Fax

Practice location:
  • Phone: 330-527-4088
  • Fax: 330-527-4089
Mailing address:
  • Phone: 330-527-4088
  • Fax: 330-527-4089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003130
License Number StateOH

VIII. Authorized Official

Name: RICHARD A SCHILLING
Title or Position: PRESIDENT
Credential: DPM
Phone: 704-786-4482