MEDICARE: LAKE COUNTY FOOT & ANKLE ASSOCIATES, LLC

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1679426852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE COUNTY FOOT & ANKLE ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	8334 MENTOR AVE STE 100
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-5757
Country	:	US
Telephone Number	:	440-357-8418
Fax Number	:	440-255-9400

Provider Business Practice Location Address
First Line	:	119 BROAD ST
Second Line	:
City	:	WADSWORTH
State	:	OH
Zip	:	44281-1851
Country	:	US
Telephone Number	:	440-357-8418
Fax Number	:	440-255-9400

Authorized Official
Title or Position	:	CRED MGR
Name	:	THERESA M FAUVER
Credential	:
Telephone Number	:	440-357-8418

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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