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General NPI Number Information
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NPI Number | 1235374687
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Entity Type | Organization
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Legal Business Name | OREGON FAMILY FOOT AND ANKLE, LLC
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 1050 ISAAC STREETS DR STE 122
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City | OREGON
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State | OH
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Zip | 43616-3243
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Country | US
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Telephone | 419-693-4171
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Fax | 419-693-6863
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Provider Business Mailing Address
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Address Line | 1050 ISAAC STREETS DR. #122
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City | OREGON
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State | OH
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Zip | 43616
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Country | US
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Telephone | 419-693-4171
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Fax | 419-693-6863
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | MR. MICHAEL D. CRAGEL
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Credential | D.P.M.
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Telephone | 419-693-4171
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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 | 2026
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 36003491
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License Number State | OH
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