Provider Demographics
NPI:1164765798
Name:WAKEFIELD, ELIZABETH BAILEY (DPM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BAILEY
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2064
Mailing Address - Country:US
Mailing Address - Phone:419-524-6772
Mailing Address - Fax:419-526-3134
Practice Address - Street 1:377 MARION AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2064
Practice Address - Country:US
Practice Address - Phone:419-524-6772
Practice Address - Fax:419-524-3134
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003948213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty