Provider Demographics
NPI:1508548603
Name:TOLEDO FOOT AND ANKLE SPECIALIST
Entity Type:Organization
Organization Name:TOLEDO FOOT AND ANKLE SPECIALIST
Other - Org Name:TOLEDO FOOT AND ANKLE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUEIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-207-5767
Mailing Address - Street 1:53 POTTER DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3607
Mailing Address - Country:US
Mailing Address - Phone:313-207-5767
Mailing Address - Fax:
Practice Address - Street 1:3128 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4132
Practice Address - Country:US
Practice Address - Phone:419-471-0079
Practice Address - Fax:419-471-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty