Healthcare Provider Details

I. General information

NPI: 1801187570
Provider Name (Legal Business Name): FRANK A LUCKINO III DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8175 MARKET ST APT. 1B
YOUNGSTOWN OH
44512-6244
US

IV. Provider business mailing address

128 WERTZ AVE NW STE #A
CANTON OH
44708
US

V. Phone/Fax

Practice location:
  • Phone: 330-629-8800
  • Fax:
Mailing address:
  • Phone: 330-477-6265
  • Fax: 330-477-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36-3689
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: