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General NPI Number Information
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NPI Number | 1619189560
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Entity Type | Organization
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Legal Business Name | FAIRLAWN FOOT & ANKLE CLINIC INC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 03/10/2014
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Provider Practice Location Address
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Address Line | 2640 W MARKET ST SUITE 301
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City | FAIRLAWN
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State | OH
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Zip | 44333-4202
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Country | US
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Telephone | 330-864-8501
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Fax |
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Provider Business Mailing Address
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Address Line | 2640 W MARKET ST SUITE 301
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City | FAIRLAWN
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State | OH
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Zip | 44333-4202
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Country | US
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Telephone | 330-864-8501
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR
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Name | MRS. KAREN S KELLOGG
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Credential | DPM
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Telephone | 330-836-6670
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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 | 36-00-3216-K
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License Number State | OH
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