Provider Demographics
NPI:1497753008
Name:ELLIOTT, DAVID K (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 HOUSLEY RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1713
Mailing Address - Country:US
Mailing Address - Phone:330-688-8624
Mailing Address - Fax:330-688-7876
Practice Address - Street 1:20 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2802
Practice Address - Country:US
Practice Address - Phone:330-630-9030
Practice Address - Fax:330-630-3554
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36 001901213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0458320Medicaid
OHELO483912Medicare ID - Type Unspecified
OH0458320Medicaid