Provider Demographics
NPI:1568641694
Name:ANNU R GOEL DPM LLC
Entity Type:Organization
Organization Name:ANNU R GOEL DPM LLC
Other - Org Name:ANNU R. GOEL DPM LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNU
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-885-4471
Mailing Address - Street 1:4913 HARROUN RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2197
Mailing Address - Country:US
Mailing Address - Phone:419-885-4471
Mailing Address - Fax:419-885-0212
Practice Address - Street 1:4913 HARROUN RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2197
Practice Address - Country:US
Practice Address - Phone:419-885-4471
Practice Address - Fax:419-885-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002768213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDG9254OtherRAILROAD MEDICARE
OH2861550Medicaid
OHDG9254OtherRAILROAD MEDICARE
OHSP04961Medicare PIN