=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154128064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKE COUNTY FOOT & ANKLE ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2025
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 BROAD ST
-----------------------------------------------------
City | WADSWORTH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44281-1851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-334-1534
-----------------------------------------------------
Fax | 440-255-9400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8334 MENTOR AVE STE 100
-----------------------------------------------------
City | MENTOR
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44060-5757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-357-8418
-----------------------------------------------------
Fax | 440-255-9400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTH OFFICIAL
-----------------------------------------------------
Name | STEPHEN JOHN FRANIA
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 440-357-8418
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------