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General NPI Number Information
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NPI Number | 1538165626
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Entity Type | Organization
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Legal Business Name | CLEVELAND FOOT AND ANKLE CLINIC
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10685 CARNEGIE AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-3018
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Country | US
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Telephone | 216-231-5612
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Fax | 216-721-5534
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Provider Business Mailing Address
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Address Line | 10515 CARNEGIE AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-3016
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Country | US
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Telephone | 216-231-3300
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Fax | 216-721-5534
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS V MELILLO
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Credential | DPM
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Telephone | 216-231-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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