Healthcare Provider Details

I. General information

NPI: 1508548603
Provider Name (Legal Business Name): TOLEDO FOOT AND ANKLE SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3128 W SYLVANIA AVE
TOLEDO OH
43613-4132
US

IV. Provider business mailing address

53 POTTER DR
BELLEVILLE MI
48111-3607
US

V. Phone/Fax

Practice location:
  • Phone: 419-471-0079
  • Fax: 419-471-0881
Mailing address:
  • Phone: 313-207-5767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: ABLA SOUEIDAN
Title or Position: MANAGER
Credential:
Phone: 313-207-5767