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General NPI Number Information
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NPI Number | 1639235351
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN OHIO FOOT & ANKLE SURGICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 5500 ARMSTRONG RD
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City | BATTLE CREEK
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State | MI
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Zip | 49037-7314
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Country | US
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Telephone | 269-966-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 ARMSTRONG RD
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City | BATTLE CREEK
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State | MI
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Zip | 49037-7314
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Country | US
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Telephone | 269-966-5600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THEODORE A. BUCCILLI JR.
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Credential | DPM
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Telephone | 330-687-7464
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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 | 36.003352
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License Number State | OH
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