MEDICARE: DR. JOSEPH ANGELO FAVAZZO D.P.M.

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	36-003320	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
2	5315240001	OTHER	OH	DMERC

General Provider Information

NPI Number	:	1518952407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ANGELO FAVAZZO D.P.M.

Provider Business Mailing Address
First Line	:	3733 PARK EAST DR
Second Line	:	SUITE 240
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4338
Country	:	US
Telephone Number	:	216-245-1290
Fax Number	:	866-571-4884

Provider Business Practice Location Address
First Line	:	8984 DARROW RD
Second Line	:	SUITE 2
City	:	TWINSBURG
State	:	OH
Zip	:	44087-2186
Country	:	US
Telephone Number	:	216-245-1290
Fax Number	:	866-571-4884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	09/07/2011

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