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General NPI Number Information
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NPI Number | 1265793111
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Entity Type | Organization
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Legal Business Name | KSU FOOT & ANKLE CLINIC
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 6000 ROCKSIDE WOODS BLVD N
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2330
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Country | US
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Telephone | 216-916-7369
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Fax | 216-916-7369
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Provider Business Mailing Address
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Address Line | 6000 ROCKSIDE WOODS BLVD. N.
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2330
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Country | US
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Telephone | 216-916-5718
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Fax | 216-916-7369
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHARLES GREENE
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Credential |
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Telephone | 330-672-2982
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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 |
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License Number State |
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