MEDICARE: CLEVELAND FOOT AND ANKLE CLINIC

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	261QP1100X	Podiatric Clinic/Center

General Provider Information

NPI Number	:	1538165626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND FOOT AND ANKLE CLINIC

Provider Business Mailing Address
First Line	:	10515 CARNEGIE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-3016
Country	:	US
Telephone Number	:	216-231-3300
Fax Number	:	216-721-5534

Provider Business Practice Location Address
First Line	:	10685 CARNEGIE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-3018
Country	:	US
Telephone Number	:	216-231-5612
Fax Number	:	216-721-5534

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS V MELILLO
Credential	:	DPM
Telephone Number	:	216-231-3300

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	08/22/2020

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