Provider Demographics
NPI:1144409962
Name:FOOT AND ANKLE OF GARRETTSVILLE CORP
Entity Type:Organization
Organization Name:FOOT AND ANKLE OF GARRETTSVILLE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:MASCHEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-527-4088
Mailing Address - Street 1:8131 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-1215
Mailing Address - Country:US
Mailing Address - Phone:330-527-4088
Mailing Address - Fax:330-527-4089
Practice Address - Street 1:8131 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-1215
Practice Address - Country:US
Practice Address - Phone:330-527-4088
Practice Address - Fax:330-527-4089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003345213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2479170Medicaid
283847344-00OtherBWC NUMBER
MA4127371Medicare PIN
OH2479170Medicaid