Healthcare Provider Details

I. General information

NPI: 1497753008
Provider Name (Legal Business Name): DAVID K ELLIOTT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SOUTH AVE
TALLMADGE OH
44278-2802
US

IV. Provider business mailing address

1329 HOUSLEY RD
STOW OH
44224-1713
US

V. Phone/Fax

Practice location:
  • Phone: 330-630-9030
  • Fax: 330-630-3554
Mailing address:
  • Phone: 330-688-8624
  • Fax: 330-688-7876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36 001901
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: