Provider Demographics
NPI:1063637114
Name:ELIZABETH M CONFALONE
Entity Type:Organization
Organization Name:ELIZABETH M CONFALONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONFALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-892-6555
Mailing Address - Street 1:4758 RIDGE RD
Mailing Address - Street 2:#161
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3327
Mailing Address - Country:US
Mailing Address - Phone:440-236-8484
Mailing Address - Fax:440-236-8470
Practice Address - Street 1:29101 HEALTH CAMPUS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5270
Practice Address - Country:US
Practice Address - Phone:440-892-6555
Practice Address - Fax:440-835-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003007-C213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0764856Medicaid
OH0764856Medicaid