Healthcare Provider Details

I. General information

NPI: 1487836847
Provider Name (Legal Business Name): HIGHLAND PODIATRY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 BRAINARD RD
HIGHLAND HTS OH
44143-3146
US

IV. Provider business mailing address

850 BRAINARD RD
HIGHLAND HTS OH
44143-3146
US

V. Phone/Fax

Practice location:
  • Phone: 440-473-0550
  • Fax: 440-473-1266
Mailing address:
  • Phone: 440-473-0550
  • Fax: 440-473-1266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36001699C
License Number StateOH

VIII. Authorized Official

Name: DR. DANIEL J CAVOLO
Title or Position: TAX ID OWNER
Credential: DPM
Phone: 440-473-0550