Provider Demographics
NPI:1801187570
Name:LUCKINO, FRANK A III (DPM)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:A
Last Name:LUCKINO
Suffix:III
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 1:128 WERTZ AVE NW STE #A
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-477-6265
Mailing Address - Fax:330-477-6306
Practice Address - Street 1:8175 MARKET ST
Practice Address - Street 2:APT. 1B
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6244
Practice Address - Country:US
Practice Address - Phone:330-629-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-3689213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0107688Medicaid
OHH316109Medicare PIN
OH0107688Medicaid