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General NPI Number Information
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NPI Number | 1073615431
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Entity Type | Organization
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Legal Business Name | ADVANCED ANATOMICAL DESIGN LLC
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 S STATE ST
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City | GIRARD
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State | OH
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Zip | 44420-2951
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Country | US
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Telephone | 330-288-0027
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Fax | 330-288-0095
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Provider Business Mailing Address
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Address Line | 375 W MAIN ST
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City | CANFIELD
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State | OH
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Zip | 44406-1433
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Country | US
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Telephone | 330-533-7207
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Fax | 330-533-7991
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Authorized Official
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Title or Position | CO PRESIDENT
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Name | MR. SEAN N KRATZER
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Credential | LO BOCO
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Telephone | 330-288-0027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | LO0209
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | LPED0061
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | LP0122
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | LO0208
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License Number State | OH
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