Healthcare Provider Details

I. General information

NPI: 1659560050
Provider Name (Legal Business Name): MASSILLON FOOT & ANKLE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 AMHERST RD NE SUITE 104
MASSILLON OH
44646
US

IV. Provider business mailing address

934 AMHERST RD NE SUITE 104
MASSILLON OH
44646
US

V. Phone/Fax

Practice location:
  • Phone: 330-833-3668
  • Fax: 330-833-2267
Mailing address:
  • Phone: 330-833-3668
  • Fax: 330-833-2267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number3130
License Number StateOH

VIII. Authorized Official

Name: DR. FRANK G STODDARD
Title or Position: CEO
Credential: D.P.M.
Phone: 330-833-3668