Provider Demographics
NPI:1831311174
Name:PERRYSBURG PODIATRY LLC
Entity Type:Organization
Organization Name:PERRYSBURG PODIATRY LLC
Other - Org Name:EDWARD F. SZABO, D.P.M.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:SZABO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-874-9702
Mailing Address - Street 1:5705 MONCLOVA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1877
Mailing Address - Country:US
Mailing Address - Phone:419-893-3711
Mailing Address - Fax:419-874-2013
Practice Address - Street 1:5705 MONCLOVA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1877
Practice Address - Country:US
Practice Address - Phone:419-893-3711
Practice Address - Fax:419-874-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003362213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH293725265002OtherMEDICAL MUTUAL PIN
OH8696700OtherCIGNA
OH2461465Medicaid
OH5001000002OtherADMINISTAR FEDERAL
OH115437OtherNATIONWIDE HEALTH PLANS
OH7807531OtherAETNA PIN
OH000000337790OtherANTHEM
OH1437186012OtherNPI TYPE-1
OH5001000002OtherADMINISTAR FEDERAL
OH7807531OtherAETNA PIN
OH9338851Medicare PIN