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General NPI Number Information
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NPI Number | 1356992598
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Entity Type | Organization
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Legal Business Name | CORNERSTONE PODIATRY LLC
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Dates
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Enumeration Date | 09/27/2019
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Last Update Date | 09/27/2019
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Provider Practice Location Address
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Address Line | 13333 LORAIN AVE
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City | CLEVELAND
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State | OH
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Zip | 44111-3400
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Country | US
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Telephone | 216-941-3388
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Fax |
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Provider Business Mailing Address
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Address Line | 27900 EUCLID AVE
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City | EUCLID
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State | OH
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Zip | 44132-3539
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Country | US
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Telephone | 216-731-3370
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY CICCERO
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Credential | DPT
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Telephone | 216-731-3370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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