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General NPI Number Information
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NPI Number | 1760618714
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Entity Type | Organization
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Legal Business Name | GLENVILLE FOOT AND ANKLE CENTER, INC.
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 10701 ST. CLAIR AVE.
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City | CLEVELAND
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State | OH
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Zip | 44108
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Country | US
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Telephone | 216-268-0800
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Fax | 216-268-0801
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Provider Business Mailing Address
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Address Line | 10701 ST. CLAIR AVE.
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City | CLEVELAND
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State | OH
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Zip | 44108
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Country | US
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Telephone | 931-206-4362
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Fax | 606-257-5039
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAI MAN LEE
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Credential | DPM
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Telephone | 216-268-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 36003361
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State | OH
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