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General NPI Number Information
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NPI Number | 1053574558
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Entity Type | Organization
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Legal Business Name | BARAK PODIATRY,LLC
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 03/22/2013
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Provider Practice Location Address
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Address Line | 6715 TIPPECANOE RD BUILDING D, SUITE 100
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City | CANFIELD
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State | OH
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Zip | 44406-8180
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Country | US
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Telephone | 330-286-0462
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Fax | 330-286-0436
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Provider Business Mailing Address
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Address Line | 6715 TIPPECANOE RD SUITE 100, BLDG D
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City | CANFIELD
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State | OH
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Zip | 44406-8180
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Country | US
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Telephone | 330-286-0462
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Fax | 330-286-0436
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Authorized Official
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Title or Position | PODIATRIST
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Name | JOSEPH MICHAEL BARAK
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Credential |
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Telephone | 330-360-6545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 003489
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License Number State | OH
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