MEDICARE: DR JAMES BANGAYAN FOOT & ANKLE SPECIALTY INC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	36003437	OH

General Provider Information

NPI Number	:	1043518194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR JAMES BANGAYAN FOOT & ANKLE SPECIALTY INC

Provider Business Mailing Address
First Line	:	5 SEVERANCE CIRCLE
Second Line	:	SUITE 804
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-1566
Country	:	US
Telephone Number	:	216-382-6501
Fax Number	:	440-382-6502

Provider Business Practice Location Address
First Line	:	5 SEVERANCE CIR
Second Line	:	SUITE 804
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-1566
Country	:	US
Telephone Number	:	216-382-6501
Fax Number	:	440-382-6502

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES P BANGAYAN
Credential	:	DPM
Telephone Number	:	440-842-6781

Provider Enumeration Date	:	03/14/2011
Last Update Date	:	11/08/2016

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