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General NPI Number Information
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NPI Number | 1992801658
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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 | 09/16/2006
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Last Update Date | 12/26/2008
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Provider Practice Location Address
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Address Line | 15644 MADISON AVE 213
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City | LAKEWOOD
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State | OH
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Zip | 44107-5622
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Country | US
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Telephone | 216-227-2194
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Fax | 216-227-2196
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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 | 330-833-5692
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Fax | 330-833-6085
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Authorized Official
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Title or Position | OWNER
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Name | KRISTINA M KOVACH
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Credential | DPM
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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