Healthcare Provider Details

I. General information

NPI: 1336052000
Provider Name (Legal Business Name): GEAUGA FOOT & ANKLE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15973 E HIGH ST
MIDDLEFIELD OH
44062
US

IV. Provider business mailing address

PO BOX 81
MIDDLEFIELD OH
44062-0081
US

V. Phone/Fax

Practice location:
  • Phone: 440-426-0070
  • Fax:
Mailing address:
  • Phone: 440-426-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: RANDALL WOOD
Title or Position: OWNER
Credential: DPM
Phone: 216-346-9400