Healthcare Provider Details

I. General information

NPI: 1487675211
Provider Name (Legal Business Name): HURON PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 UNIVERSITY DR E SUITE A
HURON OH
44839-9173
US

IV. Provider business mailing address

2320 UNIVERSITY DR E SUITE A
HURON OH
44839-9173
US

V. Phone/Fax

Practice location:
  • Phone: 419-433-4800
  • Fax: 419-433-4833
Mailing address:
  • Phone: 419-433-4800
  • Fax: 419-433-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: ANGELA FRAIFOGL
Title or Position: OFFICE MANAGER/PODIATRIST
Credential: DPM
Phone: 419-433-4800