Healthcare Provider Details

I. General information

NPI: 1962549352
Provider Name (Legal Business Name): WESTLAKE FOOT AND ANKLE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29101 HEALTH CAMPUS DR STE 200
WESTLAKE OH
44145-5266
US

IV. Provider business mailing address

29101 HEALTH CAMPUS DR STE 200
WESTLAKE OH
44145-5266
US

V. Phone/Fax

Practice location:
  • Phone: 440-835-1999
  • Fax: 440-835-1996
Mailing address:
  • Phone: 440-835-1999
  • Fax: 440-835-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number3600169T
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT G TESTA
Title or Position: D.P.M.
Credential: D.P.M.
Phone: 440-835-1999