Healthcare Provider Details

I. General information

NPI: 1942295001
Provider Name (Legal Business Name): RICHMOND FOOT & ANKLE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 RICHMOND RD SUITE 201
RICHMOND HEIGHTS OH
44143-2704
US

IV. Provider business mailing address

464 RICHMOND RD SUITE 201
RICHMOND HEIGHTS OH
44143-2704
US

V. Phone/Fax

Practice location:
  • Phone: 216-481-6654
  • Fax: 216-481-3185
Mailing address:
  • Phone: 216-481-6654
  • Fax: 216-481-3185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003112
License Number StateOH

VIII. Authorized Official

Name: DR. VADIM GLUKH
Title or Position: PHYSICIAN
Credential: DPM
Phone: 216-481-6654