Provider Demographics
NPI:1235651555
Name:CORRIGAN PODIATRY GROUP
Entity Type:Organization
Organization Name:CORRIGAN PODIATRY GROUP
Other - Org Name:CORRIGAN PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-871-3400
Mailing Address - Street 1:28687 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-3810
Mailing Address - Country:US
Mailing Address - Phone:440-871-3400
Mailing Address - Fax:
Practice Address - Street 1:1740 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4201
Practice Address - Country:US
Practice Address - Phone:440-282-1221
Practice Address - Fax:440-960-0010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORRIGAN PODIATRY GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003355213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0195494Medicaid