Healthcare Provider Details

I. General information

NPI: 1255721833
Provider Name (Legal Business Name): OHIO PODIATRIC PHYSICIANS AND SURGEONS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 AMHERST RD NE
MASSILLON OH
44646-4568
US

IV. Provider business mailing address

934 AMHERST RD NE
MASSILLON OH
44646-4568
US

V. Phone/Fax

Practice location:
  • Phone: 330-833-3668
  • Fax:
Mailing address:
  • Phone: 330-833-3668
  • Fax:

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