Provider Demographics
NPI:1073295820
Name:LAKE COUNTY FOOT & ANKLE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LAKE COUNTY FOOT & ANKLE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:INKROTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-239-9444
Mailing Address - Street 1:3255 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1967
Mailing Address - Country:US
Mailing Address - Phone:614-239-9444
Mailing Address - Fax:
Practice Address - Street 1:8334 MENTOR AVE STE 100
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5757
Practice Address - Country:US
Practice Address - Phone:440-357-8418
Practice Address - Fax:440-255-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty