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General NPI Number Information
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NPI Number | 1639275951
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Entity Type | Organization
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Legal Business Name | NORTHERN OHIO FOOT & ANKLE
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 04/30/2010
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Provider Practice Location Address
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Address Line | 29001 CEDAR RD STE 309
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City | LYNDHURST
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State | OH
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Zip | 44124-4041
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Country | US
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Telephone | 440-461-0777
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Fax | 440-646-2433
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Provider Business Mailing Address
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Address Line | 29001 CEDAR RD 309
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City | LYNDHURST
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State | OH
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Zip | 44124-4062
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Country | US
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Telephone | 440-461-0777
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Fax | 440-646-2433
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. MICHAEL FORMAN
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Credential |
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Telephone | 440-461-0777
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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 | 36001417
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License Number State | OH
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