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General NPI Number Information
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NPI Number | 1104015304
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Entity Type | Organization
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Legal Business Name | JASON T BAKICH DPM LLC
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 29101 HEALTH CAMPUS DR
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City | WESTLAKE
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State | OH
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Zip | 44145-5270
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Country | US
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Telephone | 440-899-4399
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Fax |
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Provider Business Mailing Address
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Address Line | 29101 HEALTH CAMPUS DR
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City | WESTLAKE
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State | OH
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Zip | 44145-5270
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Country | US
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Telephone | 440-899-4399
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASON T BAKICH
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Credential | DPM
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Telephone | 440-899-4399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36003043
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License Number State | OH
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