=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043226558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM ZACCARDELLI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6688 RIDGE RD SUITE 1405
-----------------------------------------------------
City | PARMA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44129-5706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-885-3161
-----------------------------------------------------
Fax | 440-885-3161
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5556 RIDGE RD
-----------------------------------------------------
City | PARMA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44129-2305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-885-3161
-----------------------------------------------------
Fax | 440-885-3161
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 36-002306
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------