MEDICARE: PRIYANKA J MUDE 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	213ES0131X	Foot Surgery Podiatrist	36.110003	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	:	1770996662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIYANKA J MUDE D.P.M.

Provider Business Mailing Address
First Line	:	8328 CLEVELAND AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4820
Country	:	US
Telephone Number	:	330-494-4949
Fax Number	:	330-494-4945

Provider Business Practice Location Address
First Line	:	8328 CLEVELAND AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4820
Country	:	US
Telephone Number	:	330-494-4949
Fax Number	:

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

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	12/06/2021

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