MEDICARE: GREATER COLUMBUS FOOT & ANKLE GROUP

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	36002713	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306998935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER COLUMBUS FOOT & ANKLE GROUP

Provider Business Mailing Address
First Line	:	3258 SULLIVANT AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1836
Country	:	US
Telephone Number	:	614-276-1190
Fax Number	:	614-457-5698

Provider Business Practice Location Address
First Line	:	3258 SULLIVANT AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1836
Country	:	US
Telephone Number	:	614-276-1190
Fax Number	:	614-457-5698

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBIN D KRAVITZ
Credential	:	DPM
Telephone Number	:	614-276-1190

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	04/25/2008

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