Healthcare Provider Details

I. General information

NPI: 1205051141
Provider Name (Legal Business Name): EMILY LOUISE EXTEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4975 FOOTE RD STE 100
MEDINA OH
44256-9048
US

IV. Provider business mailing address

3975 EMBASSY PKWY
AKRON OH
44333-8320
US

V. Phone/Fax

Practice location:
  • Phone: 330-721-8232
  • Fax: 330-721-7905
Mailing address:
  • Phone: 330-670-4091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number52635
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.129789
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: