MEDICARE: NORTHEAST OHIO FOOT AND ANKLE SPECIALISTS 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	213ES0103X	Foot & Ankle Surgery Podiatrist	36003689	OH

General Provider Information

NPI Number	:	1922527118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST OHIO FOOT AND ANKLE SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	4900 FRANK AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44720-7483
Country	:	US
Telephone Number	:	330-477-6265
Fax Number	:	330-477-6306

Provider Business Practice Location Address
First Line	:	4900 FRANK AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44720-7483
Country	:	US
Telephone Number	:	330-477-6265
Fax Number	:	330-477-6306

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FRANK LUCKINO
Credential	:	DPM
Telephone Number	:	330-477-6265

Provider Enumeration Date	:	09/19/2017
Last Update Date	:	12/19/2023

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