MEDICARE: NORTH CANTON PODIATRY INC

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

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	:	1851056204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CANTON PODIATRY INC

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	:

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	:	OWNER
Name	:	PRIYANKA J MUDE
Credential	:	DPM
Telephone Number	:	330-494-4949

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	04/07/2022

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Directions to “NORTH CANTON PODIATRY INC ” Practice Location

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