Provider Demographics
NPI:1487836847
Name:HIGHLAND PODIATRY ASSOCIATES INC
Entity Type:Organization
Organization Name:HIGHLAND PODIATRY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TAX ID OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAVOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-473-0550
Mailing Address - Street 1:850 BRAINARD RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3146
Mailing Address - Country:US
Mailing Address - Phone:440-473-0550
Mailing Address - Fax:440-473-1266
Practice Address - Street 1:850 BRAINARD RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-3146
Practice Address - Country:US
Practice Address - Phone:440-473-0550
Practice Address - Fax:440-473-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001699C213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000166644OtherANTHEM
OH0305959Medicaid
OH3206958OtherAETNA
OH=========007OtherMEDICAL MUTUAL
OH000000166644OtherANTHEM
OH3206958OtherAETNA
OH=========OtherANTARES
OH=========OtherANTARES
OH9927901Medicare PIN