Healthcare Provider Details

I. General information

NPI: 1083541122
Provider Name (Legal Business Name): BALANCE FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4073 N JEFFERSON ST
MEDINA OH
44256-5622
US

IV. Provider business mailing address

4073 N JEFFERSON ST
MEDINA OH
44256-5622
US

V. Phone/Fax

Practice location:
  • Phone: 216-658-0111
  • Fax: 216-658-0110
Mailing address:
  • Phone: 216-658-0111
  • Fax: 216-658-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: KAREN S COGAR
Title or Position: AM
Credential:
Phone: 216-712-6556