=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063401032
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARC D DOLCE DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2005
-----------------------------------------------------
Last Update Date | 04/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 368 MILAN AVE SUITE A
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44857-3106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-660-0099
-----------------------------------------------------
Fax | 419-660-0098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 378
-----------------------------------------------------
City | SANDUSKY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44871-0378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-626-6161
-----------------------------------------------------
Fax | 419-502-3511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 36-003148
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------