MEDICARE: THE LOWER EXTREMITY SPECIALTY ALLIANCE, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician
2	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1003440363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LOWER EXTREMITY SPECIALTY ALLIANCE, LTD

Provider Business Mailing Address
First Line	:	440 E STATE ST
Second Line	:
City	:	ALLIANCE
State	:	OH
Zip	:	44601-4910
Country	:	US
Telephone Number	:	330-821-6438
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 E STATE ST
Second Line	:
City	:	ALLIANCE
State	:	OH
Zip	:	44601-4910
Country	:	US
Telephone Number	:	330-821-6438
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID BISHOP
Credential	:	DPM
Telephone Number	:	330-821-6438

Provider Enumeration Date	:	02/26/2020
Last Update Date	:	06/03/2026

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