Provider Demographics
NPI:1073260832
Name:NORTH EASTERN OHIO PODIATRY GROUP LLC
Entity Type:Organization
Organization Name:NORTH EASTERN OHIO PODIATRY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-953-3668
Mailing Address - Street 1:35010 CHARDON RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9011
Mailing Address - Country:US
Mailing Address - Phone:440-953-3668
Mailing Address - Fax:440-953-3556
Practice Address - Street 1:24755 CHAGRIN BLVD
Practice Address - Street 2:SUITE 135
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5682
Practice Address - Country:US
Practice Address - Phone:440-953-3668
Practice Address - Fax:440-953-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty