Healthcare Provider Details

I. General information

NPI: 1518952407
Provider Name (Legal Business Name): JOSEPH ANGELO FAVAZZO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8984 DARROW RD SUITE 2
TWINSBURG OH
44087-2186
US

IV. Provider business mailing address

3733 PARK EAST DR SUITE 240
BEACHWOOD OH
44122-4338
US

V. Phone/Fax

Practice location:
  • Phone: 216-245-1290
  • Fax: 866-571-4884
Mailing address:
  • Phone: 216-245-1290
  • Fax: 866-571-4884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36-003320
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: