=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225214125
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOUIS L. ENDRESS DPM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2008
-----------------------------------------------------
Last Update Date | 01/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2914 CLEVELAND RD
-----------------------------------------------------
City | WOOSTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44691-1655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-262-5106
-----------------------------------------------------
Fax | 330-334-6232
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 PONDVIEW CIR
-----------------------------------------------------
City | RITTMAN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44270-9639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-334-7617
-----------------------------------------------------
Fax | 330-334-6232
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LOUIS L ENDRESS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 330-334-7617
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213EP1101X
-----------------------------------------------------
Taxonomy Name | Primary Podiatric Medicine Podiatrist
-----------------------------------------------------
License Number | 36-001566
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------