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General NPI Number Information
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NPI Number | 1205438199
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Entity Type | Organization
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Legal Business Name | ERIE FOOT AND ANKLE CENTER, LLC
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Dates
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Enumeration Date | 11/15/2020
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 23175 COMMERCE PARK STE C
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City | BEACHWOOD
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State | OH
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Zip | 44122-5806
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Country | US
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Telephone | 440-588-8197
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Fax |
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Provider Business Mailing Address
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Address Line | 23175 COMMERCE PARK STE C
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City | BEACHWOOD
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State | OH
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Zip | 44122-5806
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Country | US
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Telephone | 440-588-8197
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELINE DONOVAN
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Credential | DPM
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Telephone | 440-735-3338
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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 |
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License Number State |
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