Provider Demographics
NPI:1396387205
Name:ANKLE AND FOOT HEALTH CLINIC INC
Entity Type:Organization
Organization Name:ANKLE AND FOOT HEALTH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-552-0999
Mailing Address - Street 1:5017 NOB HILL DR UNIT 7
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-3348
Mailing Address - Country:US
Mailing Address - Phone:440-552-0999
Mailing Address - Fax:
Practice Address - Street 1:200 INDUSTRIAL PKWY STE 4D
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-4422
Practice Address - Country:US
Practice Address - Phone:440-552-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty