Provider Demographics
NPI:1487675211
Name:HURON PODIATRY LLC
Entity Type:Organization
Organization Name:HURON PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAIFOGL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-433-4800
Mailing Address - Street 1:2320 UNIVERSITY DR E SUITE A
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-9173
Mailing Address - Country:US
Mailing Address - Phone:419-433-4800
Mailing Address - Fax:419-433-4833
Practice Address - Street 1:2320 UNIVERSITY DR E SUITE A
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-9173
Practice Address - Country:US
Practice Address - Phone:419-433-4800
Practice Address - Fax:419-433-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2522023Medicaid
HU9349121Medicare PIN
OH2522023Medicaid
OH2522023Medicaid