Provider Demographics
NPI:1235374687
Name:OREGON FAMILY FOOT AND ANKLE, LLC
Entity Type:Organization
Organization Name:OREGON FAMILY FOOT AND ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-693-4171
Mailing Address - Street 1:1050 ISAAC STREETS DR. #122
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616
Mailing Address - Country:US
Mailing Address - Phone:419-693-4171
Mailing Address - Fax:419-693-6863
Practice Address - Street 1:1050 ISAAC STREETS DR STE 122
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3243
Practice Address - Country:US
Practice Address - Phone:419-693-4171
Practice Address - Fax:419-693-6863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003491213ES0103X
OH2026213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2861390Medicaid
OH0497752Medicaid
OH6190570001Medicare NSC
OH9379811Medicare PIN
OHFE4248891Medicare UPIN
OHV02007Medicare UPIN
T80537Medicare UPIN