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General NPI Number Information
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NPI Number | 1720312069
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Entity Type | Organization
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Legal Business Name | THE FOOT AND ANKLE CLINIC LLC
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 32900 DETROIT RD
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City | AVON
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State | OH
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Zip | 44011-2018
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Country | US
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Telephone | 440-937-6201
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 80690
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City | CANTON
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State | OH
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Zip | 44708-0690
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRISTINA KOVACH
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Credential | M.D.
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Telephone | 216-227-2194
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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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