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General NPI Number Information
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NPI Number | 1740736503
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Entity Type | Individual
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Provider Name | ELENI KIDANU
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Gender | Female
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 01/26/2020
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Provider Practice Location Address
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Address Line | 27100
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City | RICHMOND HEIGHTS
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State | OH
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Zip | 44143
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Country | US
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Telephone | 216-952-4505
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Fax |
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Provider Business Mailing Address
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Address Line | 6804 CLAASEN AVE
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City | CLEVELAND
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State | OH
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Zip | 44105-4928
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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 |
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Name |
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Credential |
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Telephone |
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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 | 59.00628
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License Number State | OH
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