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General NPI Number Information
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NPI Number | 1295157626
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Entity Type | Organization
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Legal Business Name | FOUNDATION FOOT & ANKLE LLC
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 2620A N WOOSTER AVE
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City | DOVER
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State | OH
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Zip | 44622-9461
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Country | US
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Telephone | 330-364-7546
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Fax | 330-364-3720
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Provider Business Mailing Address
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Address Line | 2620A N WOOSTER AVE
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City | DOVER
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State | OH
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Zip | 44622-9461
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Country | US
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Telephone | 330-364-7546
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Fax | 330-364-3720
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. LEE RUSSELL SAYNER
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Credential | DPM
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Telephone | 330-364-7546
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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 | 36003372
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License Number State | OH
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